Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 302926 | SC |
NPI | 1093793309 |
---|---|
Provider Name | Dr. David W. Jones |
First Address | Spartanburg, SC 29301-1531 |
Second Address | Spartanburg, SC 29301-1531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 08/07/2007 |