Provider Demographics
NPI:1497767214
Name:JONES, CHARLES ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ARTHUR
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 1:1120 S PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4619
Mailing Address - Country:US
Mailing Address - Phone:815-235-7165
Mailing Address - Fax:815-235-4870
Practice Address - Street 1:1120 S PARK BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4619
Practice Address - Country:US
Practice Address - Phone:815-235-7165
Practice Address - Fax:815-235-4870
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-169871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice