Provider Demographics
NPI:1306936588
Name:JONES, CHARLES BLANCHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BLANCHARD
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-8111
Mailing Address - Country:US
Mailing Address - Phone:843-221-4746
Mailing Address - Fax:843-221-4750
Practice Address - Street 1:3535 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-8111
Practice Address - Country:US
Practice Address - Phone:843-221-4746
Practice Address - Fax:843-221-4750
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6238890001Medicare NSC