Provider Demographics
NPI:1548225659
Name:JONES, BRIAN TIMOTHY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TIMOTHY
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1051
Mailing Address - Country:US
Mailing Address - Phone:864-676-9873
Mailing Address - Fax:864-676-9870
Practice Address - Street 1:202 OREGON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1051
Practice Address - Country:US
Practice Address - Phone:864-676-9873
Practice Address - Fax:864-676-9870
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4107122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4107Medicaid