Individual
TAKIYA JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
11414 W MARKHAM ST STE A, LITTLE ROCK, AR 72211-2847
(501) 404-0529
Mailing address
3321 S BOWMAN RD APT 14311, LITTLE ROCK, AR 72211-4607
(501) 554-5997
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4604
AR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/06/2022
Last updated
07/15/2022
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