Provider Demographics
NPI:1750436770
Name:MEDEIROS, JEFFREY ALLAN (DDS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:MEDEIROS
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 1:48 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857
Mailing Address - Country:US
Mailing Address - Phone:603-659-3341
Mailing Address - Fax:603-659-4418
Practice Address - Street 1:48 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEWMARKET
Practice Address - State:NH
Practice Address - Zip Code:03857
Practice Address - Country:US
Practice Address - Phone:603-659-3341
Practice Address - Fax:603-659-4418
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH023471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice