Provider Demographics
NPI:1770544876
Name:JONES, THERON M (DMD)
Entity type:Individual
Prefix:
First Name:THERON
Middle Name:M
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 CAMPBELLTON RD SW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8046
Mailing Address - Country:US
Mailing Address - Phone:706-627-3054
Mailing Address - Fax:404-349-8058
Practice Address - Street 1:5819 CAMPBELLTON RD SW
Practice Address - Street 2:SUITE 103
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8046
Practice Address - Country:US
Practice Address - Phone:706-627-3054
Practice Address - Fax:404-349-8058
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214781223G0001X
GA0130611223G0001X
TN83381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice