MEDICARE: DR. JEFFREY BARLOW 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	15929	FL

General Provider Information

NPI Number	:	1396860060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY BARLOW D.D.S.

Provider Business Mailing Address
First Line	:	105 N GROVE ST
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3441
Country	:	US
Telephone Number	:	321-459-1313
Fax Number	:	321-459-9494

Provider Business Practice Location Address
First Line	:	105 N GROVE ST
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3441
Country	:	US
Telephone Number	:	321-459-1313
Fax Number	:	321-459-9494

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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