Provider Demographics
NPI:1003915026
Name:JONES, PHILLIP L (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:L
Last Name:JONES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5348 N 500 E
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:IN
Mailing Address - Zip Code:46783-9155
Mailing Address - Country:US
Mailing Address - Phone:260-672-1371
Mailing Address - Fax:
Practice Address - Street 1:303 EAST SECOND STREET
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:IN
Practice Address - Zip Code:46783-0039
Practice Address - Country:US
Practice Address - Phone:260-672-3347
Practice Address - Fax:260-672-8351
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006467A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice