Provider Demographics
NPI:1083633440
Name:IRWIN, JEFFREY WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:IRWIN
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 1:601 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:MEYERSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15552-1421
Mailing Address - Country:US
Mailing Address - Phone:814-634-5961
Mailing Address - Fax:814-634-9799
Practice Address - Street 1:601 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:MEYERSDALE
Practice Address - State:PA
Practice Address - Zip Code:15552-1421
Practice Address - Country:US
Practice Address - Phone:814-634-5961
Practice Address - Fax:814-634-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021025L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist