Provider Demographics
NPI:1104030097
Name:EOFF, JERRY LEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LEN
Last Name:EOFF
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:PO BOX 1298
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79831-1298
Mailing Address - Country:US
Mailing Address - Phone:432-837-5190
Mailing Address - Fax:
Practice Address - Street 1:405 EAST AVENUE E
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830
Practice Address - Country:US
Practice Address - Phone:432-837-5190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist