Provider Demographics
NPI:1891723862
Name:DANNER, JEFFREY CARL (DDS, PLLC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CARL
Last Name:DANNER
Suffix:
Gender:M
Credentials:DDS, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-5006
Mailing Address - Country:US
Mailing Address - Phone:405-375-3857
Mailing Address - Fax:
Practice Address - Street 1:901 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-5006
Practice Address - Country:US
Practice Address - Phone:405-375-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100108540BMedicaid
OK731614925OtherTAX ID