Provider Demographics
NPI:1962620815
Name:JONES, RANDY PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:PAUL
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 1:4335 HIGHLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1671
Mailing Address - Country:US
Mailing Address - Phone:863-644-3571
Mailing Address - Fax:863-647-1410
Practice Address - Street 1:4335 HIGHLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1671
Practice Address - Country:US
Practice Address - Phone:863-644-3571
Practice Address - Fax:863-647-1410
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDOOO74261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice