Healthcare Provider Details

I. General information

NPI: 1275678609
Provider Name (Legal Business Name): RASHAD M JEFFERSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 58TH ST N
CLEARWATER FL
33760-3758
US

IV. Provider business mailing address

14100 58TH ST N
CLEARWATER FL
33760-3758
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8181
  • Fax: 727-824-8165
Mailing address:
  • Phone: 727-824-8181
  • Fax: 727-824-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: