Healthcare Provider Details

I. General information

NPI: 1629700083
Provider Name (Legal Business Name): DR. C. JONES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 MARKET ST STE 204
WILMINGTON NC
28411-8430
US

IV. Provider business mailing address

506 MACON CT
WILMINGTON NC
28412-2094
US

V. Phone/Fax

Practice location:
  • Phone: 910-409-6025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. CASEY JONES
Title or Position: AUTHORIZED OFFICIAL
Credential: DMD
Phone: 646-594-5400