Provider Demographics
NPI:1669480786
Name:JONES, KENNETH THOMAS III (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:THOMAS
Last Name:JONES
Suffix:III
Gender:M
Credentials:DDS
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Mailing Address - Street 1:36302 W OLD HIGHWAY 270
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-8824
Mailing Address - Country:US
Mailing Address - Phone:405-973-5844
Mailing Address - Fax:405-270-5139
Practice Address - Street 1:921 NE 13TH ST
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5007
Practice Address - Country:US
Practice Address - Phone:405-270-5139
Practice Address - Fax:405-290-1650
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX174891223P0700X
OK40791223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics