Provider Demographics
NPI:1275552408
Name:JEFFRIES, CANDYSE LOUANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CANDYSE
Middle Name:LOUANNE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 DIXIE HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2176
Mailing Address - Country:US
Mailing Address - Phone:859-282-8844
Mailing Address - Fax:
Practice Address - Street 1:7205 DIXIE HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2176
Practice Address - Country:US
Practice Address - Phone:859-282-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics