Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6137 | CO |
NPI | 1043286107 |
---|---|
Provider Name | Dr. Michael D Jones |
First Address | Boulder, CO 80301-3950 |
Second Address | Boulder, CO 80301-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 08/07/2007 |