Provider Demographics
NPI:1750418356
Name:LAVERONI, JEFFREY ROSS (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROSS
Last Name:LAVERONI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4738
Mailing Address - Country:US
Mailing Address - Phone:408-842-6660
Mailing Address - Fax:408-847-8718
Practice Address - Street 1:1335 1ST ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4738
Practice Address - Country:US
Practice Address - Phone:408-842-6660
Practice Address - Fax:408-847-8718
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice