Basic Information
| Provider Information | |||||||||
| NPI: | 1659597235 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHIFF | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | BLDG 38717, 38TH STREET | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FT GORDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309055660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067876927 | ||||||||
| FaxNumber: | 7067872081 | ||||||||
| Practice Location | |||||||||
| Address1: | CAMP SHELBY DENTAL CLINIC | ||||||||
| Address2: | BLDG 1450, 14TH STREET | ||||||||
| City: | CAMP SHELBY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015582575 | ||||||||
| FaxNumber: | 6015582235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 5063 | FL | Y | Dental Providers | Dentist |
No ID Information.