Provider Demographics
NPI:1316003155
Name:ATKINSON, JEFFREY P (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:ATKINSON
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 1:119 N ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570
Mailing Address - Country:US
Mailing Address - Phone:903-628-5436
Mailing Address - Fax:903-628-9619
Practice Address - Street 1:119 N ELLIS ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570
Practice Address - Country:US
Practice Address - Phone:903-628-5436
Practice Address - Fax:903-628-9619
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX178351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice