Provider Demographics
NPI:1467544809
Name:JEFFRIES, JERRY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:J
Last Name:JEFFRIES
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 1:1122 S WALDRON RD
Mailing Address - Street 2:
Mailing Address - City:FT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903
Mailing Address - Country:US
Mailing Address - Phone:479-452-4333
Mailing Address - Fax:
Practice Address - Street 1:1122 S WALDRON RD
Practice Address - Street 2:
Practice Address - City:FT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-452-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist