Provider Demographics
NPI:1184870107
Name:NEFF, JACQUELINE KAY (DENTURIST)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:KAY
Last Name:NEFF
Suffix:
Gender:F
Credentials:DENTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3216
Mailing Address - Country:US
Mailing Address - Phone:208-667-8997
Mailing Address - Fax:208-666-1746
Practice Address - Street 1:1119 N 4TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3216
Practice Address - Country:US
Practice Address - Phone:208-667-8997
Practice Address - Fax:208-666-1746
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-10
Last Update Date:2008-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDL.D. 43122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist