Provider Demographics
NPI:1316060668
Name:EASTON, JEFFREY W (DDS, MS, MS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:EASTON
Suffix:
Gender:M
Credentials:DDS, MS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3968 PINE GROVE RD.
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4218
Mailing Address - Country:US
Mailing Address - Phone:810-984-2208
Mailing Address - Fax:810-984-4916
Practice Address - Street 1:3968 PINE GROVE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4218
Practice Address - Country:US
Practice Address - Phone:810-984-2208
Practice Address - Fax:810-984-4916
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0134411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics