MEDICARE: CARL JONES DDS INC

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1316433840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL JONES DDS INC

Provider Business Mailing Address
First Line	:	1360 BEDFORD DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-1992
Country	:	US
Telephone Number	:	321-242-7550
Fax Number	:	321-242-7110

Provider Business Practice Location Address
First Line	:	1360 BEDFORD DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-1992
Country	:	US
Telephone Number	:	321-242-7550
Fax Number	:	321-242-7110

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	PHIL GRAVES
Credential	:
Telephone Number	:	321-622-0440

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	07/09/2018

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