DR. FANASY PROKOP JEFCOAT (NPI# 1154401909) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154401909 |
| Entity Type | Individual |
| Full Name | DR. FANASY PROKOP JEFCOAT |
| Credential | D.M.D., MS |
| Practice Address |
101 Webster Circle Suite 100 Madison MS 39110 |
| Mailing Address |
2044 Tidewater Ln Madison MS 39110-8927 |
| Practice Telephone | 6016056511 |
| Practice Fax Number | 6016056508 |
| Mailing Telephone | 6016056511 |
| Mailing Fax Number | 6016056508 |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2017-02-07 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
3251-03 | MS | Dental Providers |
| Street Address |
101 WEBSTER CIRCLE SUITE 100 |
| City | MADISON |
| State | MS |
| Zip Code | 39110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134784689 | Therapy South - Gluckstadt LLC | Physical Therapist | 1716 Us 51, Ste N, Madison, MS 39110 | 2019-05-09 |
| 1871054098 | Summit Medical Solutions | Durable Medical Equipment & Medical Supplies | 107 Azalea Street, Madison, MS 39110 | 2019-03-29 |
| 1912488198 | Madison Medical Compounding Pharmacy | Pharmacy | 111 Fountains Blvd. Building B Ste. A, Madison, MS 39110 | 2018-08-24 |
| 1679061469 | Nuvena Vein Clinic | Anesthesiology | 120 Fountains Blvd, Madison, MS 39110 | 2018-04-26 |
| 1467960484 | Brick City Drugs, LLC | Durable Medical Equipment & Medical Supplies | 159 Fountains Blvd, Madison, MS 39110 | 2018-01-11 |
| 1093227589 | Hannah Monk Hawthorne | Counselor | 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 | 2017-10-25 |
| 1548786650 | Kimberly Allen | Pharmacist | 1100 Us- 51, Madison, MS 39110 | 2017-08-21 |
| 1891218186 | Delta Elizabeth Stark | Chiropractor | 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 | 2017-07-19 |
| 1861914848 | Laura Hartlein | Dietitian, Registered | 200 Park Circle Dr. #2, Flowood, MS 39110 | 2017-07-12 |
| 1831620608 | Ona Irby | Occupational Therapist | 105 Munich Dr, Madison, MS 39110 | 2017-03-23 |
| Find all providers in zip 39110 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407019557 | Nicole Ann Marquis | Dentist | 51 Boston Post Rd, Suite 10, Madison, CT 06443-2155 | 2008-07-09 |
| 1265501787 | Steven W Segall Dds Sc | Dentist | 4002 Monona Drive, Madison, WI 53716-1138 | 2006-11-07 |
| 1053400945 | Kenneth Donald Neidhart | Dentist | 2705 Marshall Ct, Madison, WI 53705-2255 | 2006-10-11 |
| 1902856255 | Michael Westreich | Dentist | 18 Madison Ave, Madison, NJ 07940-1433 | 2006-05-10 |
| 1487643789 | Donald Benjamin Weeks | Dentist | 149 Durham Rd, Suite 32, Madison, CT 06443-2677 | 2005-10-19 |
| 1740437151 | Steven Walter Segall | Dentist | 4002 Monona Drive, Madison, WI 53716-1138 | 2008-08-27 |
| 1053539106 | Maria E Parrella | Dentist | 40 Prospect St, Madison, NJ 07940-2641 | 2007-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497112825 | Mississippi Periodontics and Implants Pllc | Dentist | 218 West Jackson Street, Ridgeland, MS 39157 | 2016-01-15 |
| 1932531373 | North Mississippi Periodontics & Implant Dentistry Pllc | Dentist | 103 Park Gate Ext, Tupelo, MS 38801-3038 | 2013-08-08 |
| 1851640437 | Ms Periodontic Specialists Group, Pllc | Dentist | 209 Woodline Dr., Flowood, MS 39232 | 2012-08-29 |
| 1790069854 | Periodontal Associates of Jackson, P.a. | Dentist | 406 Briarwood Dr., Ste. 101, Jackson, MS 39206 | 2011-10-06 |
| 1992997159 | Rodney C Richardson | Dentist | 1609 24th Ave, Meridian, MS 39301-3112 | 2007-08-13 |
| 1699966770 | Brenda Lyle Fowler | Dentist | 2408 S Lamar Blvd, Suite 3, Oxford, MS 38655-5345 | 2007-08-05 |
| 1730385139 | Bernard Frederick Podlin | Dentist | 400 Pass Road, Gulfport, MS 39507 | 2007-06-22 |
| 1417166703 | R. Clarke Stewart | Dentist | 406 Briarwood Dr Ste 101, Jackson, MS 39206-3059 | 2007-05-22 |
| 1750594412 | James Michael Robertson | Dentist | 103 Parkgate Drive Extended, Tupelo, MS 38801-3038 | 2007-05-08 |
| 1134341407 | Nichols Periodontics LLC | Dentist | 2401 5th Street North, Suite 2, Columbus, MS 39705 | 2007-05-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.