Provider Demographics
NPI:1083762488
Name:PHEBUS, JEFFREY GARLAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GARLAND
Last Name:PHEBUS
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 1:6673 VALLENDAR CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-9119
Mailing Address - Country:US
Mailing Address - Phone:901-377-5067
Mailing Address - Fax:
Practice Address - Street 1:1331 N GERMANTOWN PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5980
Practice Address - Country:US
Practice Address - Phone:901-755-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS47771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice