Provider Demographics
NPI:1972270890
Name:JEFFREY S. PAXMAN, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JEFFREY S. PAXMAN, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-363-5075
Mailing Address - Street 1:243 GREENBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4289
Mailing Address - Country:US
Mailing Address - Phone:909-363-5075
Mailing Address - Fax:
Practice Address - Street 1:245 TERRACINA BLVD STE 211A
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4878
Practice Address - Country:US
Practice Address - Phone:909-363-5075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery