Provider Demographics
NPI:1760498505
Name:JEFFERY A. DAUGHENBAUGH, D.D.S., INC
Entity Type:Organization
Organization Name:JEFFERY A. DAUGHENBAUGH, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DAUGHENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-757-3951
Mailing Address - Street 1:780 E ROMIE LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4223
Mailing Address - Country:US
Mailing Address - Phone:831-757-3951
Mailing Address - Fax:831-757-1432
Practice Address - Street 1:780 E ROMIE LN
Practice Address - Street 2:SUITE E
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4223
Practice Address - Country:US
Practice Address - Phone:831-757-3951
Practice Address - Fax:831-757-1432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty