Provider Demographics
NPI:1669551156
Name:DEXTER, JEFFERSON SODIN (DMD)
Entity type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:SODIN
Last Name:DEXTER
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 1:99 OLD MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664
Mailing Address - Country:US
Mailing Address - Phone:508-394-7107
Mailing Address - Fax:508-398-1679
Practice Address - Street 1:99 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664
Practice Address - Country:US
Practice Address - Phone:508-398-3322
Practice Address - Fax:508-398-1675
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD209081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice