Provider Demographics
NPI:1053346981
Name:JEFFERY, MATHEW S (DDS)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:S
Last Name:JEFFERY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MATHEW
Other - Middle Name:MICHAEL
Other - Last Name:JEFFERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:600 ORONDO AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2800
Mailing Address - Country:US
Mailing Address - Phone:509-662-6000
Mailing Address - Fax:509-664-4590
Practice Address - Street 1:600 ORONDO AVE
Practice Address - Street 2:STE 1
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2800
Practice Address - Country:US
Practice Address - Phone:509-664-3860
Practice Address - Fax:509-664-4585
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABJ9378630OtherDEA REGISTRATION