MEDICARE: DR. JAY L. AJMO 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	122300000X	Dentist	DN10869	FL

General Provider Information

NPI Number	:	1174678072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY L. AJMO D.D.S.

Provider Business Mailing Address
First Line	:	7100 FAIRWAY DR
Second Line	:	SUITE 59
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3777
Country	:	US
Telephone Number	:	561-627-8666
Fax Number	:	561-627-9169

Provider Business Practice Location Address
First Line	:	7100 FAIRWAY DR
Second Line	:	SUITE 59
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3777
Country	:	US
Telephone Number	:	561-627-8666
Fax Number	:	561-627-9169

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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