Healthcare Provider Details

I. General information

NPI: 1013179530
Provider Name (Legal Business Name): JOYCE ANN JEFFRIES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9674 EAGLE RANCH RD NW SUITE 1
ALBUQUERQUE NM
87114-1580
US

IV. Provider business mailing address

9674 EAGLE RANCH RD NW SUITE 1
ALBUQUERQUE NM
87114-1580
US

V. Phone/Fax

Practice location:
  • Phone: 505-348-0087
  • Fax: 505-796-5155
Mailing address:
  • Phone: 505-348-0087
  • Fax: 505-796-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD0901
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDD3715
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: