Provider Demographics
NPI:1528441003
Name:JEFFREY DENTAL CLINIC PLLC
Entity type:Organization
Organization Name:JEFFREY DENTAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MCKINZIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:JEFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-678-4151
Mailing Address - Street 1:304 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:FL
Mailing Address - Zip Code:32580-1233
Mailing Address - Country:US
Mailing Address - Phone:850-678-4151
Mailing Address - Fax:
Practice Address - Street 1:304 GLEN AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:FL
Practice Address - Zip Code:32580-1233
Practice Address - Country:US
Practice Address - Phone:850-678-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty