Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | IL |
NPI | 1013121748 |
---|---|
Provider Name | David Lynn Jones |
First Address | Naperville, IL 60540-6459 |
Second Address | Naperville, IL 60540-1112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |