Provider Demographics
NPI:1952645012
Name:LUZADER, JEFFERY OLIVER (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:OLIVER
Last Name:LUZADER
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 1:888 BESTGATE RD STE 213
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2953
Mailing Address - Country:US
Mailing Address - Phone:410-224-7556
Mailing Address - Fax:
Practice Address - Street 1:888 BESTGATE RD STE 213
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2953
Practice Address - Country:US
Practice Address - Phone:410-224-7556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics