Provider Demographics
NPI:1134154693
Name:JONES, SUSAN BARR (DMD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BARR
Last Name:JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-6412
Mailing Address - Country:US
Mailing Address - Phone:910-738-4770
Mailing Address - Fax:910-737-6567
Practice Address - Street 1:800 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-6412
Practice Address - Country:US
Practice Address - Phone:910-738-4770
Practice Address - Fax:910-737-6567
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14318122300000X
NC8292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN14318OtherFLORIDA STATE LICENSE
NC8292OtherNORTH CAROLINA LICENSE
NC8292OtherNORTH CAROLINA LICENSE