Provider Demographics
NPI:1326167271
Name:WAXMAN, JEFFREY ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:WAXMAN
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 1:2500 EAST AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-3124
Mailing Address - Country:US
Mailing Address - Phone:585-385-4270
Mailing Address - Fax:585-641-2171
Practice Address - Street 1:2500 EAST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-3124
Practice Address - Country:US
Practice Address - Phone:585-385-4270
Practice Address - Fax:585-641-2171
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0425631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice