Provider Demographics
NPI:1912125832
Name:JEFFERY-MOHR DENTISTRY, INC.
Entity type:Organization
Organization Name:JEFFERY-MOHR DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:JEFFERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-238-5810
Mailing Address - Street 1:685 FOX RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2471
Mailing Address - Country:US
Mailing Address - Phone:419-238-5810
Mailing Address - Fax:419-238-9802
Practice Address - Street 1:685 FOX RD
Practice Address - Street 2:SUITE 103
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2471
Practice Address - Country:US
Practice Address - Phone:419-238-5810
Practice Address - Fax:419-238-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022173122300000X
OH14382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty