MEDICARE: DR. JACQUELINE LEE WEST DMD

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	DN15889	FL

General Provider Information

NPI Number	:	1447269188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE LEE WEST DMD

Provider Business Mailing Address
First Line	:	2301 PARK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204
Country	:	US
Telephone Number	:	904-387-3333
Fax Number	:	904-384-7353

Provider Business Practice Location Address
First Line	:	2301 PARK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204
Country	:	US
Telephone Number	:	904-387-3333
Fax Number	:	904-384-7353

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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