Provider Demographics
NPI:1023015401
Name:JONES, GORDON K (DDS)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:K
Last Name:JONES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 N MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1377
Mailing Address - Country:US
Mailing Address - Phone:847-502-0197
Mailing Address - Fax:
Practice Address - Street 1:1541 N MCKINLEY RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1377
Practice Address - Country:US
Practice Address - Phone:847-502-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0194991223G0001X
NC0042121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice