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NPI Code Detail

MEDICARE: KRISTEN JEFFERSON DDS

MEDICARE:   KRISTEN  JEFFERSON  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
11223G0001XGeneral Practice Dentistry30124TX

General Provider Information

NPI Number : 1952717811
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN JEFFERSON DDS
Provider Business Mailing Address
First Line : 2403 LACY LN
Second Line :
City : CARROLLTON
State : TX
Zip : 75006-6514
Country : US
Telephone Number : 972-869-3789
Fax Number :
Provider Business Practice Location Address
First Line : 1403 N LOOP 336 W STE C
Second Line :
City : CONROE
State : TX
Zip : 77304-3672
Country : US
Telephone Number : 936-539-4867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2014
Last Update Date : 07/10/2014

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Directions to “ KRISTEN JEFFERSON DDS” Practice Location

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