Provider Demographics
NPI:1245325083
Name:JAGEMAN, JEFF ARTHUR (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:ARTHUR
Last Name:JAGEMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1440
Mailing Address - Country:US
Mailing Address - Phone:814-464-0960
Mailing Address - Fax:814-464-0969
Practice Address - Street 1:343 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1440
Practice Address - Country:US
Practice Address - Phone:814-464-0960
Practice Address - Fax:814-464-0969
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024453L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist