Provider Demographics
NPI:1992893309
Name:MCBRIDE, JEFFREY S (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S NAPPANEE ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1955
Mailing Address - Country:US
Mailing Address - Phone:574-293-8211
Mailing Address - Fax:574-295-8270
Practice Address - Street 1:117 S NAPPANEE ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1955
Practice Address - Country:US
Practice Address - Phone:574-293-8211
Practice Address - Fax:574-295-8270
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120089261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083627OtherANTHEM PROVIDER #
IN000000083627OtherANTHEM PROVIDER #