Provider Demographics
NPI:1396725529
Name:JONES, DARRYL LAMAR (DDS)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:LAMAR
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 1:1700 WEDGEWOOD DR
Mailing Address - Street 2:APT. #303
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1274
Mailing Address - Country:US
Mailing Address - Phone:847-662-9717
Mailing Address - Fax:
Practice Address - Street 1:3001 A 6TH STREET
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice