Provider Demographics
NPI:1700863693
Name:JEFFRIES, CHRISTIAN T (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:T
Last Name:JEFFRIES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1513
Mailing Address - Country:US
Mailing Address - Phone:724-456-6773
Mailing Address - Fax:
Practice Address - Street 1:6 GROVE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1513
Practice Address - Country:US
Practice Address - Phone:724-456-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025362L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH234403Medicaid
PA0018152710006Medicaid
PA0018152710002Medicaid