Provider Demographics
NPI:1588745590
Name:JONES, CHARLES DAVID JR (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:JONES
Suffix:JR
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 1:8811 EAST RENO
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7726
Mailing Address - Country:US
Mailing Address - Phone:405-737-7613
Mailing Address - Fax:405-737-5135
Practice Address - Street 1:8811 E RENO AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7731
Practice Address - Country:US
Practice Address - Phone:405-737-7613
Practice Address - Fax:405-737-5135
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1000042820AMedicaid