Provider Demographics
NPI:1235201955
Name:JONES, LAUREN BROCK (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:BROCK
Last Name:JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-4064
Mailing Address - Country:US
Mailing Address - Phone:601-250-5907
Mailing Address - Fax:601-250-5948
Practice Address - Street 1:722 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4064
Practice Address - Country:US
Practice Address - Phone:601-250-5907
Practice Address - Fax:601-250-5948
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3299-041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09877251Medicaid