MEDICARE: DR. JAY RIFKIND 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	122300000X	Dentist	12007510A	IN

General Provider Information

NPI Number	:	1568520120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY RIFKIND D.D.S.

Provider Business Mailing Address
First Line	:	1701 LIBRARY BLVD
Second Line	:	STE. K
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1567
Country	:	US
Telephone Number	:	317-881-1700
Fax Number	:	317-881-7878

Provider Business Practice Location Address
First Line	:	1701 LIBRARY BLVD
Second Line	:	STE. K
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1567
Country	:	US
Telephone Number	:	317-881-1700
Fax Number	:	317-881-7878

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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