Provider Demographics
NPI:1326229329
Name:CIOFFI, JERRY A (DMD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:A
Last Name:CIOFFI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:GERALD
Other - Middle Name:A
Other - Last Name:CIOFFI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:767 BLANDING BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065
Mailing Address - Country:US
Mailing Address - Phone:904-272-6244
Mailing Address - Fax:904-276-0038
Practice Address - Street 1:767 BLANDING BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-8721
Practice Address - Country:US
Practice Address - Phone:904-272-6244
Practice Address - Fax:904-276-0038
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 115771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL63093Medicare PIN