Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 1412 | WY |
Y | 1223X0400X | Orthodontists | 1412 | WY |
NPI | 1043724610 |
---|---|
Provider Name | Barak Troy Jones |
First Address | Davie, FL 33324-4823 |
Second Address | Casper, WY 82604-3279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2017 |
Last Update Date | 18/11/2017 |