Provider Demographics
NPI:1134254881
Name:JONES, LARRY TED (DMD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:TED
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1134
Mailing Address - Country:US
Mailing Address - Phone:256-492-6363
Mailing Address - Fax:256-492-0047
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1134
Practice Address - Country:US
Practice Address - Phone:256-492-6363
Practice Address - Fax:256-492-0047
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-93747OtherBLUE CROSS BLUE SHIELD
AL510-93747OtherBLUE CROSS BLUE SHIELD