Provider Demographics
NPI:1649488321
Name:JONES, THERESA G (DMD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:G
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 1:382 COURTHOUSE RD STE B
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1864
Mailing Address - Country:US
Mailing Address - Phone:228-604-2445
Mailing Address - Fax:
Practice Address - Street 1:382 COURTHOUSE RD STE B
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1864
Practice Address - Country:US
Practice Address - Phone:228-604-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS202283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist