Provider Demographics
NPI:1194008581
Name:ELLEFSON, JENNIFER EMMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:EMMA
Last Name:ELLEFSON
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 1:1800 MCGINNIS CT
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8033
Mailing Address - Country:US
Mailing Address - Phone:254-698-7062
Mailing Address - Fax:
Practice Address - Street 1:600 INDIAN TRL
Practice Address - Street 2:STE. 202
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1312
Practice Address - Country:US
Practice Address - Phone:254-699-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist