MEDICARE: DR. JEFFREY OLIVER CAPES D.M.D., M.D.

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	011515	GA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	045781	GA

General Provider Information

NPI Number	:	1336271543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY OLIVER CAPES D.M.D., M.D.

Provider Business Mailing Address
First Line	:	110 OFFICE PARK LN STE 104
Second Line	:
City	:	ST SIMONS ISLAND
State	:	GA
Zip	:	31522-6604
Country	:	US
Telephone Number	:	912-634-6600
Fax Number	:	912-634-3882

Provider Business Practice Location Address
First Line	:	110 OFFICE PARK LANE
Second Line	:	SUITE 104
City	:	ST SIMONS ISLAND
State	:	GA
Zip	:	31522-3152
Country	:	US
Telephone Number	:	912-634-6600
Fax Number	:	912-634-3882

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	04/29/2019

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