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General NPI Number Information
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NPI Number | 1801921622
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Entity Type | Individual
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Provider Name | JEFFERY KIRK MACHEN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1295 CHURCH ST
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City | ZACHARY
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State | LA
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Zip | 70791-2347
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Country | US
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Telephone | 225-654-1490
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Fax | 225-654-2023
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Provider Business Mailing Address
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Address Line | 1295 CHURCH ST
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City | ZACHARY
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State | LA
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Zip | 70791-2347
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Country | US
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Telephone | 225-654-1490
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Fax | 225-654-2023
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3983
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License Number State | LA
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