Healthcare Provider Details

I. General information

NPI: 1619800109
Provider Name (Legal Business Name): JEFFREY DENTAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 CARMEL MOUNTAIN RD STE A
SAN DIEGO CA
92129-2159
US

IV. Provider business mailing address

1455 MISSOURI ST APT 1
SAN DIEGO CA
92109-3058
US

V. Phone/Fax

Practice location:
  • Phone: 929-422-8102
  • Fax:
Mailing address:
  • Phone: 929-422-8102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA JEFFREY
Title or Position: PRESIDENT
Credential: DMD
Phone: 929-422-8102