Provider Demographics
NPI:1598727653
Name:THE DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:THE DENTAL GROUP, LLC
Other - Org Name:BLAIR A. JONES, DMD, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DENTISIT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-645-8993
Mailing Address - Street 1:34359 CARPENTERS WAY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4910
Mailing Address - Country:US
Mailing Address - Phone:302-645-8993
Mailing Address - Fax:302-645-4506
Practice Address - Street 1:34359 CARPENTERS WAY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4910
Practice Address - Country:US
Practice Address - Phone:302-645-8993
Practice Address - Fax:302-645-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000023517Medicaid
DE1000023543Medicaid
DE1000033058Medicaid
DE1000023518Medicaid