# JACK L. BOONE, DDS, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689840654
- **Authorized official:** DR. JACK LEE BOONE DDS (DDS)
- **Authorized official phone:** (252) 426-5585

## Contact information

- **Practice address:** 212 AINSLEY AVE, HERTFORD, NC 27944-1400
- **Practice address phone:** (252) 426-5585
- **Practice address fax:** (252) 426-5766
- **Mailing address:** 212 AINSLEY AVE, HERTFORD, NC 27944-1400
- **Mailing address phone:** (252) 426-5585
- **Mailing address fax:** (252) 426-5766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3868 | NC | Yes |

## Other

- **Enumeration date:** 04/30/2008
- **Last updated:** 04/30/2008