Provider Demographics
NPI:1598175929
Name:JONES, COREY STEVEN
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:STEVEN
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:COREY
Other - Middle Name:STEVEN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:130 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-4606
Mailing Address - Country:US
Mailing Address - Phone:312-201-1610
Mailing Address - Fax:
Practice Address - Street 1:130 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-4606
Practice Address - Country:US
Practice Address - Phone:312-201-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH32081223X0400X
IL019030088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics