Provider Demographics
NPI:1972367647
Name:TSE, JEFFREY (DDS, MSC, FRCD(C))
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:TSE
Suffix:
Gender:M
Credentials:DDS, MSC, FRCD(C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4875 VOLUNTEER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2118
Mailing Address - Country:US
Mailing Address - Phone:954-787-7878
Mailing Address - Fax:
Practice Address - Street 1:4875 VOLUNTEER RD STE 100
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-2118
Practice Address - Country:US
Practice Address - Phone:786-300-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty