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General NPI Number Information
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NPI Number | 1265579056
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Entity Type | Individual
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Provider Name | MARKO JEFTIC
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 188 FRIES MILL RD STE G-1
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-2015
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Country | US
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Telephone | 856-262-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 371 MARTIN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19128-4842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DI 02200200
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License Number State | NJ
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