Provider Demographics
NPI:1932190469
Name:JONES, SAM P IV (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:P
Last Name:JONES
Suffix:IV
Gender:M
Credentials:DDS, MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 108811
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8811
Mailing Address - Country:US
Mailing Address - Phone:405-848-7974
Mailing Address - Fax:405-848-0033
Practice Address - Street 1:1218 E 9TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5796
Practice Address - Country:US
Practice Address - Phone:405-285-7466
Practice Address - Fax:405-285-5166
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK52311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH70410Medicare UPIN