Provider Demographics
NPI:1316162548
Name:PAFFENROTH, JEFFREY JON (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JON
Last Name:PAFFENROTH
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:W6393 FIRELANE 8
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-9746
Mailing Address - Country:US
Mailing Address - Phone:920-730-0122
Mailing Address - Fax:
Practice Address - Street 1:828 N WESTHILL BLVD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5788
Practice Address - Country:US
Practice Address - Phone:920-733-2445
Practice Address - Fax:920-733-5281
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3127-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice