Healthcare Provider Details

I. General information

NPI: 1710312293
Provider Name (Legal Business Name): JEFFREY ALAN PRICE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

117 LAZELLE RD SUITE D
COLUMBUS OH
43235-8605
US

IV. Provider business mailing address

117 LAZELLE RD SUITE D
COLUMBUS OH
43235-8605
US

V. Phone/Fax

Practice location:
  • Phone: 614-888-3212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30.023485
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: