Provider Demographics
NPI:1659597235
Name:SCHIFF, JON EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:EDWARD
Last Name:SCHIFF
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:BLDG 38717, 38TH STREET
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5660
Mailing Address - Country:US
Mailing Address - Phone:706-787-6927
Mailing Address - Fax:706-787-2081
Practice Address - Street 1:CAMP SHELBY DENTAL CLINIC
Practice Address - Street 2:BLDG 1450, 14TH STREET
Practice Address - City:CAMP SHELBY
Practice Address - State:MS
Practice Address - Zip Code:39407
Practice Address - Country:US
Practice Address - Phone:601-558-2575
Practice Address - Fax:601-558-2235
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist