MEDICARE: DR. CHARLES EDWARD JONES D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8196	TX

General Provider Information

NPI Number	:	1083638167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES EDWARD JONES D.D.S.

Provider Business Mailing Address
First Line	:	3105 W 15TH ST
Second Line	:	SUITE A-1
City	:	PLANO
State	:	TX
Zip	:	75075-7700
Country	:	US
Telephone Number	:	972-596-3405
Fax Number	:	972-964-5180

Provider Business Practice Location Address
First Line	:	3105 W 15TH ST
Second Line	:	SUITE A-1
City	:	PLANO
State	:	TX
Zip	:	75075-7700
Country	:	US
Telephone Number	:	972-596-3405
Fax Number	:	972-964-5180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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