Provider Demographics
NPI:1346380920
Name:SITAR, JEFFERY EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:EDWARD
Last Name:SITAR
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 1:304 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-1621
Mailing Address - Country:US
Mailing Address - Phone:319-385-8912
Mailing Address - Fax:319-385-4532
Practice Address - Street 1:304 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-1621
Practice Address - Country:US
Practice Address - Phone:319-385-8912
Practice Address - Fax:319-385-4532
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA75861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0156091Medicaid