MEDICARE: AIMEE LEE MASSEY D.D.S.

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	25822	TX

General Provider Information

NPI Number	:	1427258573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE LEE MASSEY D.D.S.

Provider Business Mailing Address
First Line	:	5540 OLD JACKSONVILLE HWY
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-3378
Country	:	US
Telephone Number	:	903-597-2121
Fax Number	:	903-581-7776

Provider Business Practice Location Address
First Line	:	5540 OLD JACKSONVILLE HWY
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-3378
Country	:	US
Telephone Number	:	903-597-2121
Fax Number	:	903-581-7776

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	08/03/2011

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