Provider Demographics
NPI:1922103753
Name:ATHERTON, JEFFREY SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:ATHERTON
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 1:7517 CAMERON ROAD
Mailing Address - Street 2:SUITE 107 LONGHORN DENTAL ASSOCIATES PC
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7517 CAMERON ROAD
Practice Address - Street 2:SUITE 106 LONGHORN DENTAL
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752
Practice Address - Country:US
Practice Address - Phone:512-371-0978
Practice Address - Fax:512-371-7283
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist