Provider Demographics
NPI:1225136088
Name:PUMPHREY, JEFFREY ROSS (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROSS
Last Name:PUMPHREY
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 1:311 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-1709
Mailing Address - Country:US
Mailing Address - Phone:812-522-8800
Mailing Address - Fax:812-522-8801
Practice Address - Street 1:311 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-1709
Practice Address - Country:US
Practice Address - Phone:812-522-8800
Practice Address - Fax:812-522-8801
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010276A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice