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General NPI Number Information
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NPI Number | 1174655047
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Entity Type | Organization
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Legal Business Name | CHARLES B JONES
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 3535 COUNTY LINE RD
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City | ANDREWS
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State | SC
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Zip | 29510-8111
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Country | US
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Telephone | 843-221-4746
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 COUNTY LINE ROAD
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City | ANDREWS
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State | SC
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Zip | 29510
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Country | US
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Telephone | 843-221-4746
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CHARLES JONES
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Credential |
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Telephone | 843-221-4746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1693
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License Number State | SC
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