Provider Demographics
NPI:1386801397
Name:JONES, MICHAEL T (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
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 1:5613 DURALEIGH RD
Mailing Address - Street 2:STE 121 & 131
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2694
Mailing Address - Country:US
Mailing Address - Phone:919-835-1710
Mailing Address - Fax:919-719-0389
Practice Address - Street 1:5710 W GATE CITY BLVD STE R
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7047
Practice Address - Country:US
Practice Address - Phone:336-294-0722
Practice Address - Fax:336-294-0735
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899006KMedicaid