Provider Demographics
NPI:1225221567
Name:JEFFUS, BROOKE JANICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:JANICE
Last Name:JEFFUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:JANICE
Other - Last Name:JEFFUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 HWY 5 N
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-9778
Mailing Address - Country:US
Mailing Address - Phone:501-315-3145
Mailing Address - Fax:501-778-1633
Practice Address - Street 1:407 HWY 5 N
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-9778
Practice Address - Country:US
Practice Address - Phone:501-315-3145
Practice Address - Fax:501-778-1633
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR36311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice