MEDICARE: DR. LEE MERLE JAMESON D.D.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	1223P0700X	Prosthodontics		IL

General Provider Information

NPI Number	:	1386852119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE MERLE JAMESON D.D.S.

Provider Business Mailing Address
First Line	:	8119 WOODCREEK CT
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-4536
Country	:	US
Telephone Number	:	630-985-9303
Fax Number	:

Provider Business Practice Location Address
First Line	:	7350 W COLLEGE DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1149
Country	:	US
Telephone Number	:	708-448-7588
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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