Provider Demographics
NPI:1649360157
Name:JONES, BERYL KENNETH II (DDS)
Entity type:Individual
Prefix:DR
First Name:BERYL
Middle Name:KENNETH
Last Name:JONES
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JONES
Other - Middle Name:FAMILY
Other - Last Name:DENTISTRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-0146
Mailing Address - Country:US
Mailing Address - Phone:740-439-5551
Mailing Address - Fax:
Practice Address - Street 1:61360 SOUTHGATE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9114
Practice Address - Country:US
Practice Address - Phone:740-439-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-4843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist