Provider Demographics
NPI:1285035527
Name:JEFFERS DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:JEFFERS DENTISTRY PARTNERSHIP
Other - Org Name:JEFFERS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-528-6343
Mailing Address - Street 1:1820 SONOMA AVE STE 42
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6617
Mailing Address - Country:US
Mailing Address - Phone:707-528-6343
Mailing Address - Fax:707-528-0316
Practice Address - Street 1:1820 SONOMA AVE STE 42
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6617
Practice Address - Country:US
Practice Address - Phone:707-528-6343
Practice Address - Fax:707-528-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty