Provider Demographics
NPI:1104034461
Name:JONES, MICHAEL RENFREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RENFREW
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 1:28985 GOLDEN LANTERN
Mailing Address - Street 2:SUITE B-101
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1567
Mailing Address - Country:US
Mailing Address - Phone:949-495-8885
Mailing Address - Fax:
Practice Address - Street 1:28985 GOLDEN LANTERN
Practice Address - Street 2:SUITE B-101
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1567
Practice Address - Country:US
Practice Address - Phone:949-495-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist