=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316054406
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY ALAN MARFURT DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 785 DELAWARE AVE
-----------------------------------------------------
City | DELMAR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-439-4114
-----------------------------------------------------
Fax | 518-439-4114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 785 DELAWARE AVE
-----------------------------------------------------
City | DELMAR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-439-4114
-----------------------------------------------------
Fax | 518-439-4114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 042066
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------