Provider Demographics
NPI:1124118203
Name:STRACHAN, JEFF C (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:C
Last Name:STRACHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 MONTAGUE ST
Mailing Address - Street 2:SUITE 800A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3610
Mailing Address - Country:US
Mailing Address - Phone:718-783-0504
Mailing Address - Fax:718-783-3855
Practice Address - Street 1:189 MONTAGUE ST
Practice Address - Street 2:SUITE 800A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3610
Practice Address - Country:US
Practice Address - Phone:718-783-0504
Practice Address - Fax:718-783-3855
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039954-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist