Provider Demographics
NPI:1659308682
Name:JONES, GARY LESLIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LESLIE
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 1:705 OGLETHORPE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2242
Mailing Address - Country:US
Mailing Address - Phone:706-546-5141
Mailing Address - Fax:706-546-7678
Practice Address - Street 1:705 OGLETHORPE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2242
Practice Address - Country:US
Practice Address - Phone:706-546-5141
Practice Address - Fax:706-546-7678
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0106871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics