Provider Demographics
NPI:1275678609
Name:JEFFERSON, RASHAD M (DDS)
Entity Type:Individual
Prefix:DR
First Name:RASHAD
Middle Name:M
Last Name:JEFFERSON
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 1:3912 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5861
Mailing Address - Country:US
Mailing Address - Phone:844-796-2797
Mailing Address - Fax:301-627-4687
Practice Address - Street 1:3912 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5861
Practice Address - Country:US
Practice Address - Phone:844-796-2797
Practice Address - Fax:301-627-4687
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125821223G0001X
DCDEN10017701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD202353628OtherTAX ID