Provider Demographics
NPI:1922260637
Name:MARK S. JEFFERIES, DMD, PLC
Entity Type:Organization
Organization Name:MARK S. JEFFERIES, DMD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:JEFFERIES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-793-1771
Mailing Address - Street 1:2465 CENTREVILLE RD
Mailing Address - Street 2:J-15
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4586
Mailing Address - Country:US
Mailing Address - Phone:703-793-1771
Mailing Address - Fax:
Practice Address - Street 1:2465 CENTREVILLE RD
Practice Address - Street 2:J-15
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4586
Practice Address - Country:US
Practice Address - Phone:703-793-1771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty