MEDICARE: DR. JEFFREY SCOTT DRAYER 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	051965-1	NY

General Provider Information

NPI Number	:	1306042155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY SCOTT DRAYER DDS

Provider Business Mailing Address
First Line	:	101 RYDER AVE
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-6129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 DEER PARK AVE
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-2701
Country	:	US
Telephone Number	:	631-586-7654
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	07/08/2007

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