1922103753 NPI number — DR. JEFFREY SCOTT ATHERTON DDS

Table of content: DR. JEFFREY SCOTT ATHERTON DDS (NPI 1922103753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922103753 NPI number — DR. JEFFREY SCOTT ATHERTON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATHERTON
Provider First Name:
JEFFREY
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922103753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7517 CAMERON ROAD
Provider Second Line Business Mailing Address:
SUITE 107 LONGHORN DENTAL ASSOCIATES PC
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7517 CAMERON ROAD
Provider Second Line Business Practice Location Address:
SUITE 106 LONGHORN DENTAL
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-371-0978
Provider Business Practice Location Address Fax Number:
512-371-7283
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  11976 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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