Provider Demographics
NPI:1689893943
Name:PLATT, JEFFERY CLAIR (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:CLAIR
Last Name:PLATT
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 1:425 W ROCKRIMMON BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1767
Mailing Address - Country:US
Mailing Address - Phone:719-528-6100
Mailing Address - Fax:719-528-6137
Practice Address - Street 1:425 W ROCKRIMMON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1767
Practice Address - Country:US
Practice Address - Phone:719-528-6100
Practice Address - Fax:719-528-6137
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO07054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist