Provider Demographics
NPI:1952524464
Name:FAVERO, JEFFREY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:FAVERO
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 1:3500 HARRISON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2058
Mailing Address - Country:US
Mailing Address - Phone:801-621-4943
Mailing Address - Fax:801-621-3608
Practice Address - Street 1:3500 HARRISON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2058
Practice Address - Country:US
Practice Address - Phone:801-621-4943
Practice Address - Fax:801-621-3608
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1417261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice