Provider Demographics
NPI:1316046089
Name:JEFFERY, DAVID E JR (DDS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:JEFFERY
Suffix:JR
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 1:214 SOUTH THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:479-636-4771
Mailing Address - Fax:479-636-1401
Practice Address - Street 1:214 SOUTH THIRD STREET
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756
Practice Address - Country:US
Practice Address - Phone:479-636-4771
Practice Address - Fax:479-636-1401
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
477344OtherUNITED CONCORDIA
58708OtherFEDERAL BCBS
2100686OtherBCBS TENNESSEE