Provider Demographics
NPI:1598286387
Name:JEFFERSON M. PECORA DMD PA
Entity Type:Organization
Organization Name:JEFFERSON M. PECORA DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:M
Authorized Official - Last Name:PECORA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-725-7644
Mailing Address - Street 1:2105 PALM BAY RD NE STE 4-5
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2937
Mailing Address - Country:US
Mailing Address - Phone:321-725-7644
Mailing Address - Fax:
Practice Address - Street 1:2105 PALM BAY RD NE STE 4-5
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2937
Practice Address - Country:US
Practice Address - Phone:321-725-7644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13729261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental