Provider Demographics
NPI:1437163482
Name:JONES, CHARLES MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:JONES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4201 SPRING VALLEY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3631
Mailing Address - Country:US
Mailing Address - Phone:972-991-1400
Mailing Address - Fax:972-991-1460
Practice Address - Street 1:4201 SPRING VALLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3631
Practice Address - Country:US
Practice Address - Phone:972-991-1400
Practice Address - Fax:972-991-1460
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice