Dr. Fanasy Prokop Jefcoat, D.M.D., MS
Dentist, Periodontics in Madison, MS. Individual provider (NPI-1).
NPI number1154401909
StatusActive
Last updated in NPPESFeb 7, 2017
Details
- NPI
- 1154401909
- Entity type
- Individual (NPI-1)
- Name
- Dr. Fanasy Prokop Jefcoat
- Credential
- D.M.D., MS
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 16, 2006
- Last updated
- Feb 7, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | 3251-03 | MS | Yes |
Practice location
101 Webster CircleSuite 100
Madison, MS 39110
Phone 601-605-6511 · Fax 601-605-6508
Mailing address
2044 Tidewater LnMadison, MS 39110-8927
Phone 601-605-6511 · Fax 601-605-6508
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