Provider Demographics
NPI:1851470280
Name:PHELPS, JEFFREY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:PHELPS
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 1:3225 WILLAMETTE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3309
Mailing Address - Country:US
Mailing Address - Phone:541-686-9715
Mailing Address - Fax:541-686-9717
Practice Address - Street 1:3225 WILLAMETTE ST STE 1
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3309
Practice Address - Country:US
Practice Address - Phone:541-686-9715
Practice Address - Fax:541-686-9717
Is Sole Proprietor?:No
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71411223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics