Provider Demographics
NPI:1548642556
Name:BROOKE JEFFUS, DDS, PLLC
Entity type:Organization
Organization Name:BROOKE JEFFUS, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-213-4590
Mailing Address - Street 1:23239 I 30
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2571
Mailing Address - Country:US
Mailing Address - Phone:501-213-4590
Mailing Address - Fax:
Practice Address - Street 1:23239 I 30
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2571
Practice Address - Country:US
Practice Address - Phone:501-213-4590
Practice Address - Fax:501-943-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR36311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225221567OtherNPI