Provider Demographics
NPI:1114004595
Name:JEFFERS, ROBERT P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:JEFFERS
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 1:42 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6615
Mailing Address - Country:US
Mailing Address - Phone:707-545-2299
Mailing Address - Fax:707-545-2947
Practice Address - Street 1:42 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6615
Practice Address - Country:US
Practice Address - Phone:707-545-2299
Practice Address - Fax:707-545-2947
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice