Provider Demographics
NPI:1467044198
Name:CARL JONES DDS INC
Entity Type:Organization
Organization Name:CARL JONES DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS/BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:321-622-0440
Mailing Address - Street 1:1360 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1992
Mailing Address - Country:US
Mailing Address - Phone:321-242-7550
Mailing Address - Fax:321-242-7110
Practice Address - Street 1:1601 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4484
Practice Address - Country:US
Practice Address - Phone:321-984-0034
Practice Address - Fax:321-984-7844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARL JONES DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty