Provider Demographics
NPI:1528126083
Name:EDER, JEFFREY (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:EDER
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 1:4959 LE CHALET BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1408
Mailing Address - Country:US
Mailing Address - Phone:561-737-8776
Mailing Address - Fax:561-572-0338
Practice Address - Street 1:4959 LE CHALET BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1408
Practice Address - Country:US
Practice Address - Phone:561-737-8776
Practice Address - Fax:561-572-0338
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL137271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics