=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558459396
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LETICIA G JEFFORDS DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 11/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7322 W MILITARY DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78227-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-673-3792
-----------------------------------------------------
Fax | 210-673-8837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7322 MILITARY DR WEST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78227-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-673-3792
-----------------------------------------------------
Fax | 210-673-8837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 18284
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------