Healthcare Provider Details

I. General information

NPI: 1407119837
Provider Name (Legal Business Name): JUSTIN ZACKARY JEFFUS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W COY SMITH HWY
MOUNT VERNON AL
36560-3201
US

IV. Provider business mailing address

PO BOX 2867
MOBILE AL
36652-2867
US

V. Phone/Fax

Practice location:
  • Phone: 251-829-9884
  • Fax: 251-829-9507
Mailing address:
  • Phone: 251-690-8158
  • Fax: 251-544-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5934 CI
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: