Provider Demographics
NPI:1306986369
Name:JEFFORDS, ERNEST GARY (DMD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:GARY
Last Name:JEFFORDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ERNEST
Other - Middle Name:GARY
Other - Last Name:JEFFORDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:443 HIGHLAND CIRCLE
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-0008
Mailing Address - Country:US
Mailing Address - Phone:803-245-5454
Mailing Address - Fax:803-245-5534
Practice Address - Street 1:474 NORTH ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1318
Practice Address - Country:US
Practice Address - Phone:803-245-5545
Practice Address - Fax:803-245-5534
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1806OtherLICENSE