Provider Demographics
NPI:1114761269
Name:JEFFERSON FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:JEFFERSON FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/DENTAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-386-3768
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-0008
Mailing Address - Country:US
Mailing Address - Phone:515-386-3768
Mailing Address - Fax:515-386-3790
Practice Address - Street 1:301 AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-2803
Practice Address - Country:US
Practice Address - Phone:515-386-3768
Practice Address - Fax:515-386-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty