Provider Demographics
NPI:1245238377
Name:WHITE, JEFFERY M (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:M
Last Name:WHITE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13701 E MISSISSIPPI AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-6141
Mailing Address - Country:US
Mailing Address - Phone:303-344-2705
Mailing Address - Fax:303-344-4125
Practice Address - Street 1:13701 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6141
Practice Address - Country:US
Practice Address - Phone:303-344-2705
Practice Address - Fax:303-344-4125
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO054891223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02054898Medicaid
CO02054898Medicaid
COT60703Medicare UPIN