Provider Demographics
NPI:1700818440
Name:SMITH, JEFFREY SCHAEFER (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCHAEFER
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 IVANREST AVE SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1400
Mailing Address - Country:US
Mailing Address - Phone:616-531-1554
Mailing Address - Fax:616-531-6947
Practice Address - Street 1:3050 IVANREST AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1400
Practice Address - Country:US
Practice Address - Phone:616-531-1554
Practice Address - Fax:616-531-6947
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI132051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics