Provider Demographics
NPI:1487608568
Name:ERNEST GARY JEFFORDS DMD PA
Entity type:Organization
Organization Name:ERNEST GARY JEFFORDS DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:JEFFORDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-245-5545
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-0008
Mailing Address - Country:US
Mailing Address - Phone:803-245-5454
Mailing Address - Fax:
Practice Address - Street 1:474 NORTH ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1318
Practice Address - Country:US
Practice Address - Phone:803-245-5545
Practice Address - Fax:803-245-5534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ18062Medicaid