Individual
MR. ETHAN YOUNG JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1001 E STUART DRIVE, GALAX, VA 24333
(276) 236-0562
(276) 236-0858
Mailing address
1001 E STUART DRIVE, GALAX, VA 24333
(276) 236-0562
(276) 236-0858
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
7909
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
743169
UNITED CONCORDIA
—
05
—
899008L
—
NC
Enumeration date
09/07/2006
Last updated
07/08/2007
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