MEDICARE: DR. JEFFREY DAVID REUTER 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	015749	MO

General Provider Information

NPI Number	:	1255599718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY DAVID REUTER DDS

Provider Business Mailing Address
First Line	:	10316 MANCHESTER RD
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-1521
Country	:	US
Telephone Number	:	314-821-4233
Fax Number	:	314-821-8382

Provider Business Practice Location Address
First Line	:	10316 MANCHESTER RD
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-1521
Country	:	US
Telephone Number	:	314-821-4233
Fax Number	:	314-821-8382

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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