Provider Demographics
NPI:1447772280
Name:MARRS, JEFFREY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:MARRS
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 1:2133 IHO CAPTAIN MARY T. KLINKER ST.
Mailing Address - Street 2:BLDG 3352
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5345
Mailing Address - Country:US
Mailing Address - Phone:817-637-8866
Mailing Address - Fax:
Practice Address - Street 1:2133 IHO CAPTAIN MARY T. KLINKER ST.
Practice Address - Street 2:BLDG 3352
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-5345
Practice Address - Country:US
Practice Address - Phone:817-637-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33086122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice