MEDICARE: JEREMY BONEBRAKE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS039986	PA

General Provider Information

NPI Number	:	1033523147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY BONEBRAKE DDS

Provider Business Mailing Address
First Line	:	196 S WASHINGTON ST
Second Line	:
City	:	GREENCASTLE
State	:	PA
Zip	:	17225-1332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 S WASHINGTON ST
Second Line	:
City	:	GREENCASTLE
State	:	PA
Zip	:	17225-1332
Country	:	US
Telephone Number	:	717-597-7424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	06/17/2014

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