MEDICARE: DELHI DENTAL ASSOC. JS BAXTER DDS INC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1548334600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELHI DENTAL ASSOC. JS BAXTER DDS INC

Provider Business Mailing Address
First Line	:	777 COLUMBUS AVE
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-1684
Country	:	US
Telephone Number	:	513-932-5856
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 COLUMBUS AVE
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-1684
Country	:	US
Telephone Number	:	513-932-5856
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY SUMNER BAXTER
Credential	:	DDS
Telephone Number	:	513-932-5856

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	10/01/2007

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