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General NPI Number Information
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NPI Number | 1316147952
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Entity Type | Organization
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Legal Business Name | JEFFRIES DENTAL, P.C.
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 3313 PAINTBRUSH LANE
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City | WORLAND
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State | WY
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Zip | 82401
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Country | US
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Telephone | 307-347-3994
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Fax | 307-347-3697
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Provider Business Mailing Address
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Address Line | 3313 PAINTBRUSH LANE
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City | WORLAND
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State | WY
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Zip | 82401
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Country | US
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Telephone | 307-347-3994
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Fax | 307-347-3697
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Authorized Official
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Title or Position | DENTIST-CO-OWNER
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Name | DR. L. CARL JEFFRIES
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Credential | D.D.S.
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Telephone | 307-388-0137
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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 | 1041
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1005
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License Number State | WY
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