Provider Demographics
NPI:1295879625
Name:CUMBERLAND, JEFFREY HARREL (DMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HARREL
Last Name:CUMBERLAND
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 1:161 SCARBROUGH ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-9027
Mailing Address - Country:US
Mailing Address - Phone:601-939-1845
Mailing Address - Fax:601-939-1807
Practice Address - Street 1:161 SCARBROUGH ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-9027
Practice Address - Country:US
Practice Address - Phone:601-939-1845
Practice Address - Fax:601-939-1807
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2263-86122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist