MEDICARE: DR. JEFFREY B SAMEROFF 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	DS 017456L	PA

General Provider Information

NPI Number	:	1356344345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY B SAMEROFF D.M.D.

Provider Business Mailing Address
First Line	:	800 HERITAGE DR
Second Line	:	SUITE 811
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-9220
Country	:	US
Telephone Number	:	610-326-3610
Fax Number	:	610-326-3494

Provider Business Practice Location Address
First Line	:	800 HERITAGE DR
Second Line	:	SUITE 811
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-9220
Country	:	US
Telephone Number	:	610-326-3610
Fax Number	:	610-326-3494

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/11/2007

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