Provider Demographics
NPI:1790944734
Name:CYNTHIA JONES, D.M.D., P.C.
Entity Type:Organization
Organization Name:CYNTHIA JONES, D.M.D., P.C.
Other - Org Name:DENTISTRY 4 KIDS
Other - Org Type:Other Name
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:DEIDE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-614-4678
Mailing Address - Street 1:3525 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6568
Mailing Address - Country:US
Mailing Address - Phone:770-614-4678
Mailing Address - Fax:770-614-4878
Practice Address - Street 1:3525 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6568
Practice Address - Country:US
Practice Address - Phone:770-614-4678
Practice Address - Fax:770-614-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012241122300000X
GADN011335122300000X
GA95601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000661438CMedicaid
GA000900974FMedicaid
GA000273996CMedicaid