Provider Demographics
NPI:1619021268
Name:FENDLEY, JEFFREY CHAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHAD
Last Name:FENDLEY
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 1:1103 RIVERY BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628
Mailing Address - Country:US
Mailing Address - Phone:512-868-0238
Mailing Address - Fax:512-868-9494
Practice Address - Street 1:1103 RIVERY BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628
Practice Address - Country:US
Practice Address - Phone:512-868-0238
Practice Address - Fax:512-868-9494
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice