MEDICARE: DR. JEFFREY W. EASTON D.D.S., M.S., M.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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	013441	MI

General Provider Information

NPI Number	:	1316060668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY W. EASTON D.D.S., M.S., M.S.

Provider Business Mailing Address
First Line	:	3968 PINE GROVE RD.
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-4218
Country	:	US
Telephone Number	:	810-984-2208
Fax Number	:	810-984-4916

Provider Business Practice Location Address
First Line	:	3968 PINE GROVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-4218
Country	:	US
Telephone Number	:	810-984-2208
Fax Number	:	810-984-4916

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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