Provider Demographics
NPI:1649726225
Name:JONES, KOFFORD, & SMITH DDS I,PLLC
Entity type:Organization
Organization Name:JONES, KOFFORD, & SMITH DDS I,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-720-2945
Mailing Address - Street 1:1400 CRESCENT GRN STE 210
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8118
Mailing Address - Country:US
Mailing Address - Phone:919-233-8830
Mailing Address - Fax:
Practice Address - Street 1:1400 CRESCENT GRN STE 210
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8118
Practice Address - Country:US
Practice Address - Phone:919-233-8830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty