Provider Demographics
NPI:1740401314
Name:JEFFREYS, CARL ERIC (DMD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:ERIC
Last Name:JEFFREYS
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:PO BOX 40498
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-0498
Mailing Address - Country:US
Mailing Address - Phone:513-522-4961
Mailing Address - Fax:513-522-4962
Practice Address - Street 1:6310 E. KEMPER RD
Practice Address - Street 2:SUITE #100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241
Practice Address - Country:US
Practice Address - Phone:513-522-4961
Practice Address - Fax:513-522-4962
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-91371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0811778Medicaid