Provider Demographics
NPI:1447584198
Name:JEFFREY, EMMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:NEW CANTON
Mailing Address - State:VA
Mailing Address - Zip Code:23123-0220
Mailing Address - Country:US
Mailing Address - Phone:434-581-3271
Mailing Address - Fax:434-581-1105
Practice Address - Street 1:25892 N JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:NEW CANTON
Practice Address - State:VA
Practice Address - Zip Code:23123
Practice Address - Country:US
Practice Address - Phone:434-581-3271
Practice Address - Fax:434-581-1105
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0380621223G0001X
VA04014131331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice