Provider Demographics
NPI:1831113125
Name:MCFADDEN, JEFFERY (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33111 W. SEVEN MILE RD.
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152
Mailing Address - Country:US
Mailing Address - Phone:248-888-8383
Mailing Address - Fax:248-888-0834
Practice Address - Street 1:33111 W. SEVEN MILE RD.
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:248-888-8383
Practice Address - Fax:248-888-0834
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017434204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124811848Medicaid
MIOH20333OtherBLUE CROSS MI
MI104818482Medicaid
MIOP23070Medicare PIN
MIOH20333OtherBLUE CROSS MI