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General NPI Number Information
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NPI Number | 1669875381
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Entity Type | Organization
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Legal Business Name | KM JEFFERS DENTAL CORP
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 1119 S STATE ST
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City | UKIAH
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State | CA
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Zip | 95482-6426
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Country | US
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Telephone | 707-462-2993
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Fax | 707-462-3999
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Provider Business Mailing Address
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Address Line | 1119 S STATE ST
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City | UKIAH
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State | CA
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Zip | 95482-6426
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Country | US
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Telephone | 707-462-2993
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Fax | 707-462-3999
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MATTHEW P JEFFERS
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Credential | D.D.S.
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Telephone | 707-462-2993
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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 | 62628
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License Number State | CA
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