Provider Demographics
NPI:1356496921
Name:TOOTHMAN, JEFFREY CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHRISTOPHER
Last Name:TOOTHMAN
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 1:81 N EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6501
Mailing Address - Country:US
Mailing Address - Phone:301-791-1770
Mailing Address - Fax:301-791-7706
Practice Address - Street 1:81 N EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6501
Practice Address - Country:US
Practice Address - Phone:301-791-1770
Practice Address - Fax:301-791-7706
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14635122300000X, 1223X0400X
NY052703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1598106056OtherLLC