Provider Demographics
NPI:1366682361
Name:DR. P.L. JEFFRIES AND ASSOCIATES, PA
Entity Type:Organization
Organization Name:DR. P.L. JEFFRIES AND ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336704-282-9961
Mailing Address - Street 1:1307 DOVE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5068
Mailing Address - Country:US
Mailing Address - Phone:704-282-9961
Mailing Address - Fax:704-282-9964
Practice Address - Street 1:1307 DOVE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5068
Practice Address - Country:US
Practice Address - Phone:704-282-9961
Practice Address - Fax:704-282-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900485Medicaid