Healthcare Provider Details

I. General information

NPI: 1659597235
Provider Name (Legal Business Name): JON EDWARD SCHIFF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMP SHELBY DENTAL CLINIC BLDG 1450, 14TH STREET
CAMP SHELBY MS
39407
US

IV. Provider business mailing address

BLDG 38717, 38TH STREET USA DENTAC
FT GORDON GA
30905-5660
US

V. Phone/Fax

Practice location:
  • Phone: 601-558-2575
  • Fax: 601-558-2235
Mailing address:
  • Phone: 706-787-6927
  • Fax: 706-787-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: