NPIMap

Organization Active NPI

KM Jeffers Dental Corp

  • General Practice Dentistry
  • Ukiah, CA
National Provider Identifier
1669875381
Registry record updated Oct 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
62628 Issued in CA
Legal business name
KM JEFFERS DENTAL CORP
Practice address
1119 S State St
Ukiah, CA 95482-6426
Phone
(707) 462-2993
Fax
(707) 462-3999
NPI assigned
Oct 8, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2014

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

Authorized official

Name
Dr. Matthew P Jeffers, D.D.S.NPI 1962883066
Title
Partner
Phone
(707) 462-2993

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 62628 CA Primary

Addresses

Primary practice location

1119 S State St
Ukiah, CA 95482-6426

Mailing address

1119 S State St
Ukiah, CA 95482-6426
Phone (707) 462-2993

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412726400000",
    "number": "1669875381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 S STATE ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954826426",
            "telephone_number": "707-462-2993",
            "fax_number": "707-462-3999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 S STATE ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954826426",
            "telephone_number": "707-462-2993",
            "fax_number": "707-462-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KM JEFFERS DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-08",
        "last_updated": "2014-10-08",
        "status": "A",
        "authorized_official_last_name": "JEFFERS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "707-462-2993",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "62628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2014; 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.