MEDICARE: F. JAY OHMES DDS LLC

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	332BC3200X	Customized Equipment (DME)	015092	MO

General Provider Information

NPI Number	:	1588032890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	F. JAY OHMES DDS LLC

Provider Business Mailing Address
First Line	:	1009 RONDALE CT
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7368
Country	:	US
Telephone Number	:	636-978-0226
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 RONDALE CT
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7368
Country	:	US
Telephone Number	:	636-978-0226
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	F JAY OHMES
Credential	:	DDS
Telephone Number	:	636-978-0226

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	09/13/2016

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