Provider Demographics
NPI:1841252269
Name:JEFFALONE, DAVID MALCOLM JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MALCOLM
Last Name:JEFFALONE
Suffix:JR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:2776 RINGGOLD ROAD
Mailing Address - Street 2:FORT SILL DENTAL ACTIVITY
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503
Mailing Address - Country:US
Mailing Address - Phone:580-442-3905
Mailing Address - Fax:580-442-4002
Practice Address - Street 1:DENTAC 2410 STANLEY ROAD
Practice Address - Street 2:SUITE 200J
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6230
Practice Address - Country:US
Practice Address - Phone:210-295-2743
Practice Address - Fax:210-295-2602
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-02-16
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Provider Licenses
StateLicense IDTaxonomies
TX20740122300000X
NY0430371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice