Provider Demographics
NPI:1275624207
Name:JEFFERIES, ROBERT DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:JEFFERIES
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 1:10780 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-3439
Mailing Address - Country:US
Mailing Address - Phone:303-452-6630
Mailing Address - Fax:303-252-0237
Practice Address - Street 1:10780 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-3439
Practice Address - Country:US
Practice Address - Phone:303-452-6630
Practice Address - Fax:303-252-0237
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO88031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice