Gregory Trandon Lee Jefferson

Primary specialty

DentistTaxonomy code 122300000X

License

25964 Issued in MT

Practice address

865 Oilfield Ave
Shelby, MT 59474-2702

Phone

(406) 434-3142

NPI assigned

Aug 4, 2022

Last updated

Aug 24, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Marias Healthcare Services Inc

  • Federally Qualified Health Center (FQHC)
  • Shelby, MT
  • NPI 1881697209
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1669109229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 AUSTIN POINT DR",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278895603",
            "telephone_number": "910-624-6765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 OILFIELD AVE",
            "city": "SHELBY",
            "state": "MT",
            "postal_code": "594742702",
            "telephone_number": "406-434-3142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFERSON",
        "first_name": "GREGORY",
        "middle_name": "TRANDON LEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-04",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MT",
            "license": "25964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brynn Hoover, LMT
• Jodi Hout
• Courtney Hovland, RN
• Heidi Lynn Hunsucker, NP
• Shelly Hunt, LCPC
• Charlene Yvette Johnson, COTA/L
• Alexander Kastner
• Robin Lynn Laine
• Larry J. Bonderud, OD (Northern Montana Eyecare)
• Rachael Lehr, APRN

• Dentist in Shelby, MT
• Providers in Shelby, MT by specialty
• Dentist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.