Provider Demographics
NPI:1396811261
Name:JONES, PEDRO R (D,DS)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:D,DS
Other - Prefix:DR
Other - First Name:PEDRO
Other - Middle Name:R
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:827 WAPPOO RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5866
Mailing Address - Country:US
Mailing Address - Phone:843-766-4999
Mailing Address - Fax:843-766-7663
Practice Address - Street 1:827 WAPPOO RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5866
Practice Address - Country:US
Practice Address - Phone:843-766-4999
Practice Address - Fax:843-766-7663
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC273361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice