Provider Demographics
NPI:1629178801
Name:DRS JEFFORDS & OFFUTT, PEDIATRIC DENTISTRY, PC
Entity Type:Organization
Organization Name:DRS JEFFORDS & OFFUTT, PEDIATRIC DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JEFFORDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:210-692-1919
Mailing Address - Street 1:14603 HUEBNER RD.
Mailing Address - Street 2:STE 701 BLDG 7
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5476
Mailing Address - Country:US
Mailing Address - Phone:210-692-1919
Mailing Address - Fax:210-692-7477
Practice Address - Street 1:14603 HUEBNER RD
Practice Address - Street 2:STE 701 BLDG 7
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5476
Practice Address - Country:US
Practice Address - Phone:210-692-1919
Practice Address - Fax:210-692-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009659601Medicaid