Provider Demographics
NPI:1679170419
Name:JONES KOFFORD & SMITH DDS IV PLLC
Entity Type:Organization
Organization Name:JONES KOFFORD & SMITH DDS IV PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-720-2945
Mailing Address - Street 1:1800 N SALEM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-8398
Mailing Address - Country:US
Mailing Address - Phone:919-720-2945
Mailing Address - Fax:
Practice Address - Street 1:2420 PENNY RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8120
Practice Address - Country:US
Practice Address - Phone:336-882-5498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental