Provider Demographics
NPI:1972740546
Name:JEFFREY R. SHOLER
Entity type:Organization
Organization Name:JEFFREY R. SHOLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-806-3981
Mailing Address - Street 1:5595 WINFIELD BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1220
Mailing Address - Country:US
Mailing Address - Phone:408-578-5595
Mailing Address - Fax:408-578-3465
Practice Address - Street 1:5595 WINFIELD BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1220
Practice Address - Country:US
Practice Address - Phone:408-578-5595
Practice Address - Fax:408-578-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN