Healthcare Provider Details

I. General information

NPI: 1356362065
Provider Name (Legal Business Name): GARY T. JONES DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 AVIEMORE DR
PINEHURST NC
28374-9797
US

IV. Provider business mailing address

93 AVIEMORE DR
PINEHURST NC
28374-9797
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-8088
  • Fax: 910-295-8855
Mailing address:
  • Phone: 910-295-8088
  • Fax: 910-295-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6685
License Number StateNC

VIII. Authorized Official

Name: MRS. AMY LYNN ANDERSON
Title or Position: BUSINESS MANGER
Credential:
Phone: 910-295-8088