Provider Demographics
NPI:1831245778
Name:JEFFERSON, YOSH (DMD)
Entity type:Individual
Prefix:DR
First Name:YOSH
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2305
Mailing Address - Country:US
Mailing Address - Phone:609-261-1199
Mailing Address - Fax:609-261-2378
Practice Address - Street 1:737 HOLLY LN
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-2305
Practice Address - Country:US
Practice Address - Phone:609-261-1199
Practice Address - Fax:609-261-2378
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ128191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice