Provider Demographics
NPI:1306853882
Name:JONES, CHARLES LAMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
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 1:223 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-2300
Mailing Address - Country:US
Mailing Address - Phone:601-583-3380
Mailing Address - Fax:601-583-7496
Practice Address - Street 1:223 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-2300
Practice Address - Country:US
Practice Address - Phone:601-583-3380
Practice Address - Fax:601-583-7496
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1718-76122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist