Provider Demographics
NPI:1902929664
Name:IGLHAUT, JEFFREY ALLAN (DDS, MS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLAN
Last Name:IGLHAUT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:A
Other - Last Name:IGLHAUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS, PA
Mailing Address - Street 1:1003 HIGH HOUSE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3585
Mailing Address - Country:US
Mailing Address - Phone:919-469-9986
Mailing Address - Fax:919-469-2034
Practice Address - Street 1:1003 HIGH HOUSE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3585
Practice Address - Country:US
Practice Address - Phone:919-469-9986
Practice Address - Fax:919-469-2034
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics