MEDICARE: DR. JEFFERY PAUL GUEST II 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	30-01-4087	OH

General Provider Information

NPI Number	:	1932112497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY PAUL GUEST II DDS

Provider Business Mailing Address
First Line	:	708 HOWELL DR
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-1530
Country	:	US
Telephone Number	:	740-344-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	1534 W CHURCH ST
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-1532
Country	:	US
Telephone Number	:	740-344-4549
Fax Number	:

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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