Provider Demographics
NPI:1750555470
Name:GREG JONES
Entity type:Organization
Organization Name:GREG JONES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD PC
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-931-3368
Mailing Address - Street 1:3704 PONTOON RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3704 PONTOON RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4240
Practice Address - Country:US
Practice Address - Phone:618-931-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3416S0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416S0300XTransportation ServicesAmbulanceWater Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0000099999Medicaid