Provider Demographics
NPI:1285681635
Name:JEFFREY, WILLIAM CLINTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLINTON
Last Name:JEFFREY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ADRIATIC DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-1902
Mailing Address - Country:US
Mailing Address - Phone:606-623-3913
Mailing Address - Fax:
Practice Address - Street 1:2165 CUNNINGHAM DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2569
Practice Address - Country:US
Practice Address - Phone:757-827-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401410953OtherSTATE LICENSE
KY8555OtherKY DENTAL LICENSE