Basic Information
| Provider Information | |||||||||
| NPI: | 1831484963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12801 TORRE PINES LN | ||||||||
| Address2: | |||||||||
| City: | YUKON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730997095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053208200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7130 W HEFNER RD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731624502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057220123 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2011 | ||||||||
| LastUpdateDate: | 06/16/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 6287 | OK | Y | Dental Providers | Dentist | General Practice |
No ID Information.