MEDICARE: DR. LETICIA G JEFFORDS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	18284	TX

General Provider Information

NPI Number	:	1558459396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LETICIA G JEFFORDS DDS

Provider Business Mailing Address
First Line	:	7322 MILITARY DR WEST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78227-2924
Country	:	US
Telephone Number	:	210-673-3792
Fax Number	:	210-673-8837

Provider Business Practice Location Address
First Line	:	7322 W MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78227-2924
Country	:	US
Telephone Number	:	210-673-3792
Fax Number	:	210-673-8837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	11/13/2013

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