Provider Demographics
NPI:1538243316
Name:DAVIDSON, JEFFREY L (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 SAINT ANDREWS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4248
Mailing Address - Country:US
Mailing Address - Phone:916-933-2848
Mailing Address - Fax:916-933-3997
Practice Address - Street 1:1011 SAINT ANDREWS DR
Practice Address - Street 2:SUITE A
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4248
Practice Address - Country:US
Practice Address - Phone:916-933-2848
Practice Address - Fax:916-933-3997
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice