Provider Demographics
NPI:1871654699
Name:CANFIELD, JEFFREY M (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:CANFIELD
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 1:1664 E RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-4143
Mailing Address - Country:US
Mailing Address - Phone:317-781-3900
Mailing Address - Fax:317-781-3943
Practice Address - Street 1:1664 E RAYMOND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-4143
Practice Address - Country:US
Practice Address - Phone:317-781-3900
Practice Address - Fax:317-781-3943
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010294A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice