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General NPI Number Information
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NPI Number | 1538729678
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Entity Type | Individual
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Provider Name | CAROL L JEFFRIES DMD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 6300 GRAND AVE
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City | GURNEE
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State | IL
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Zip | 60031-4538
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Country | US
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Telephone | 224-214-4902
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 MUSEUM BLVD UNIT 307
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City | VERNON HILLS
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State | IL
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Zip | 60061-3194
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Country | US
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Telephone | 703-470-3791
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 105209
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.032074
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License Number State | IL
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