Provider Demographics
NPI:1033313374
Name:JONES, THOMAS RANDOLPH (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RANDOLPH
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-0307
Mailing Address - Country:US
Mailing Address - Phone:276-346-1030
Mailing Address - Fax:
Practice Address - Street 1:#3 CHURCH ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263-0307
Practice Address - Country:US
Practice Address - Phone:276-346-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010037471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice