Provider Demographics
NPI:1386044865
Name:JONES AND KOFFORD CARY NC PLLC
Entity Type:Organization
Organization Name:JONES AND KOFFORD CARY NC PLLC
Other - Org Name:ROYAL OAK DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-468-4211
Mailing Address - Street 1:200 CORNERSTONE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8428
Mailing Address - Country:US
Mailing Address - Phone:919-468-4211
Mailing Address - Fax:919-882-9458
Practice Address - Street 1:200 CORNERSTONE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8428
Practice Address - Country:US
Practice Address - Phone:919-468-4211
Practice Address - Fax:919-882-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9696122300000X
NC9695122300000X
NC9665122300000X
NC96641223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty