Provider Demographics
NPI:1427036060
Name:PRIETO, JEFFREY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:PRIETO
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 1:1950 MILLER ST
Mailing Address - Street 2:SUITES 3 AND 4
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4759
Mailing Address - Country:US
Mailing Address - Phone:904-269-3488
Mailing Address - Fax:904-278-0931
Practice Address - Street 1:1950 MILLER ST
Practice Address - Street 2:SUITES 3 AND 4
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4759
Practice Address - Country:US
Practice Address - Phone:904-269-3488
Practice Address - Fax:904-278-0931
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN143581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice