Provider Demographics
NPI:1962580423
Name:JONES, GLEN EARL (DMD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:EARL
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 1:168 14TH ST SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-6103
Mailing Address - Country:US
Mailing Address - Phone:727-585-5494
Mailing Address - Fax:727-584-1820
Practice Address - Street 1:168 14TH ST SW
Practice Address - Street 2:SUITE B
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-6103
Practice Address - Country:US
Practice Address - Phone:727-585-5494
Practice Address - Fax:727-584-1820
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00129486Medicare ID - Type UnspecifiedRAIL ROAD
FL54914ZMedicare ID - Type UnspecifiedNE
FL97405Medicare ID - Type UnspecifiedL & NE GROUP
FL97405AMedicare ID - Type UnspecifiedTYRONE GROUP
FL54914ZMedicare ID - Type UnspecifiedLARGO
FL592332536Medicare UPIN
FL54914YMedicare ID - Type UnspecifiedTYRONE