Provider Demographics
NPI:1083888648
Name:PFEFFER, JEREMY ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ALAN
Last Name:PFEFFER
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 1:16 HAMPTON VILLAGE PLZ
Mailing Address - Street 2:SUITE #229
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2128
Mailing Address - Country:US
Mailing Address - Phone:314-353-1851
Mailing Address - Fax:
Practice Address - Street 1:16 HAMPTON VILLAGE PLZ
Practice Address - Street 2:SUITE #229
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2128
Practice Address - Country:US
Practice Address - Phone:314-353-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070172581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice