Provider Demographics
NPI:1104071182
Name:JONES, RANDALL C (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:C
Last Name:JONES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3347
Mailing Address - Country:US
Mailing Address - Phone:970-522-6280
Mailing Address - Fax:970-522-6281
Practice Address - Street 1:503 POPLAR ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3347
Practice Address - Country:US
Practice Address - Phone:970-522-6280
Practice Address - Fax:970-522-6281
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist