Provider Demographics
NPI:1871610840
Name:JONES, RANDALL C (DMD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:C
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 1:14896 FERNS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-9656
Mailing Address - Country:US
Mailing Address - Phone:503-623-9473
Mailing Address - Fax:503-838-4751
Practice Address - Street 1:1004 MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-1323
Practice Address - Country:US
Practice Address - Phone:503-838-0434
Practice Address - Fax:503-838-4751
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR71 0969871OtherGENERAL DENTISTY