Provider Demographics
NPI:1164518239
Name:JONES, TRENT LAMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:LAMAR
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 1:1040 EAGLES LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9072
Mailing Address - Country:US
Mailing Address - Phone:678-836-2136
Mailing Address - Fax:678-289-8560
Practice Address - Street 1:1 BALTIMORE PL NW
Practice Address - Street 2:SUITE 403
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2116
Practice Address - Country:US
Practice Address - Phone:404-685-8605
Practice Address - Fax:404-685-8605
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-01-25
Deactivation Date:2013-05-28
Deactivation Code:
Reactivation Date:2013-11-19
Provider Licenses
StateLicense IDTaxonomies
GADN0011661122300000X
GA116611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00733983CMedicaid