Individual
DR. FANASY PROKOP JEFCOAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D., MS
Contact information
Practice address
101 WEBSTER CIRCLE, SUITE 100, MADISON, MS 39110
(601) 605-6511
(601) 605-6508
Mailing address
2044 TIDEWATER LN, MADISON, MS 39110-8927
(601) 605-6511
(601) 605-6508
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
3251-03
MS
Other
Enumeration date
10/16/2006
Last updated
02/07/2017
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