Provider Demographics
NPI:1568625515
Name:MOKRIS, JEFFREY BRADFORD (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRADFORD
Last Name:MOKRIS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 RICHARDS XING
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8910
Mailing Address - Country:US
Mailing Address - Phone:803-818-0783
Mailing Address - Fax:
Practice Address - Street 1:1700 FIRST BAXTER XING
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8948
Practice Address - Country:US
Practice Address - Phone:803-547-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC70021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics