Provider Demographics
NPI:1528036308
Name:JEFFERS, ROBERT DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:JEFFERS
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 1:550 THORNTON PKWY
Mailing Address - Street 2:SUITE 240A
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2100
Mailing Address - Country:US
Mailing Address - Phone:303-280-8878
Mailing Address - Fax:303-280-8993
Practice Address - Street 1:550 E. THORNTON PKWY
Practice Address - Street 2:SUITE 240A
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2100
Practice Address - Country:US
Practice Address - Phone:303-280-8878
Practice Address - Fax:303-280-8993
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN001047841223G0001X
NE45661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0519927-13Medicaid
NE5257OtherBCBS PROVIDER NUMBER