Provider Demographics
NPI:1871564781
Name:RENDER, JEFFERY DAVID (DDS)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:DAVID
Last Name:RENDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:RECEPTION / MEDICAL CENTER
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-0628
Mailing Address - Country:US
Mailing Address - Phone:386-496-6171
Mailing Address - Fax:386-496-6545
Practice Address - Street 1:7765 S COUNTY ROAD 231
Practice Address - Street 2:RECEPTION / MEDICAL CENTER
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-5721
Practice Address - Country:US
Practice Address - Phone:386-496-6171
Practice Address - Fax:396-486-6545
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZD33871223S0112X
FLDTC 1471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery