Provider Demographics
NPI:1821287269
Name:JEFFERY S. ACKERMAN D.D.S. LTD.
Entity Type:Organization
Organization Name:JEFFERY S. ACKERMAN D.D.S. LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:SHELDON
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDSMAGD
Authorized Official - Phone:703-968-7022
Mailing Address - Street 1:5502 FIRESIDE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3712
Mailing Address - Country:US
Mailing Address - Phone:703-323-4626
Mailing Address - Fax:
Practice Address - Street 1:5701 CENTRE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1916
Practice Address - Country:US
Practice Address - Phone:703-968-7022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty