Provider Demographics
NPI:1568192821
Name:MOUNT, JEFFREY TANNER (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TANNER
Last Name:MOUNT
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4873 WILLIAMS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2428
Mailing Address - Country:US
Mailing Address - Phone:512-508-6104
Mailing Address - Fax:
Practice Address - Street 1:4873 WILLIAMS DR STE 105
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-2428
Practice Address - Country:US
Practice Address - Phone:512-508-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97401223G0001X
TX363291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice