Provider Demographics
NPI:1336346758
Name:JONES, MALCOLM FORT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:FORT
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:FORT
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:9600 TWO NOTCH RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4304
Mailing Address - Country:US
Mailing Address - Phone:803-788-3707
Mailing Address - Fax:
Practice Address - Street 1:9600 TWO NOTCH RD
Practice Address - Street 2:SUITE 8
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4304
Practice Address - Country:US
Practice Address - Phone:803-788-3707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist