Provider Demographics
NPI:1134154693
Name:JONES, SUSAN BARR (DMD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BARR
Last Name:JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 HERON POINT LN
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-4073
Mailing Address - Country:US
Mailing Address - Phone:910-988-7602
Mailing Address - Fax:
Practice Address - Street 1:8209 W BEAVER ST STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32220-2393
Practice Address - Country:US
Practice Address - Phone:904-293-1931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8292122300000X
FLDN14318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8292OtherNORTH CAROLINA LICENSE
FLDN14318OtherFLORIDA STATE LICENSE
NC8292OtherNORTH CAROLINA LICENSE