Provider Demographics
NPI:1780804294
Name:HREHA, JEFFERY P (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:P
Last Name:HREHA
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W HIGHWAY 89A STE B4
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5767
Mailing Address - Country:US
Mailing Address - Phone:928-204-9213
Mailing Address - Fax:928-204-9215
Practice Address - Street 1:1120 W HIGHWAY 89A STE B4
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5767
Practice Address - Country:US
Practice Address - Phone:928-204-9213
Practice Address - Fax:928-204-9215
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD43011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics