Provider Demographics
NPI:1013179530
Name:JEFFRIES, JOYCE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ANN
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9674 EAGLE RANCH RD NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1580
Mailing Address - Country:US
Mailing Address - Phone:505-348-0087
Mailing Address - Fax:505-796-5155
Practice Address - Street 1:9674 EAGLE RANCH RD NW
Practice Address - Street 2:SUITE 1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1580
Practice Address - Country:US
Practice Address - Phone:505-348-0087
Practice Address - Fax:505-796-5155
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD09011223S0112X
NMDD37151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1013179530Medicaid
SD1013179530Medicaid