# BETHANIEL S JEFFERSON, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487832945
- **Authorized official:** BETHANIEL JEFFERSON (OWNER)
- **Authorized official phone:** (281) 895-7787

## Contact information

- **Practice address:** 15531 KUYKENDAHL RD, STE 180, HOUSTON, TX 77090-3645
- **Practice address phone:** (281) 895-7787
- **Mailing address:** 15531 KUYKENDAHL RD, STE 180, HOUSTON, TX 77090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |

## Other

- **Enumeration date:** 02/07/2008
- **Last updated:** 02/07/2008