1093811234 NPI number — ROBERT S. JONES DMD PC

Table of content: (NPI 1093811234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093811234 NPI number — ROBERT S. JONES DMD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT S. JONES DMD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093811234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4130 CARMICHAEL RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36106-3670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-277-5666
Provider Business Mailing Address Fax Number:
334-277-9947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4130 CARMICHAEL RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36106-3670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-277-5666
Provider Business Practice Location Address Fax Number:
334-277-9947
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
SINCLAIR
Authorized Official Title or Position:
OWNER DENTIST
Authorized Official Telephone Number:
334-277-5666

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3773 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 4484 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51093499 . This is a "BLUE CROSS BLUE SHIELD AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 806960 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51517847 . This is a "BLUE CROSS BLUE SHIELD AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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