MEDICARE: JEFFREY L EZEKIEL DDS PC

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	0401007624	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568632370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY L EZEKIEL DDS PC

Provider Business Mailing Address
First Line	:	3301 HAMPTON HWY STE M
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-2967
Country	:	US
Telephone Number	:	757-867-5003
Fax Number	:	757-867-5006

Provider Business Practice Location Address
First Line	:	3301 HAMPTON HWY STE M
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-2967
Country	:	US
Telephone Number	:	757-867-5003
Fax Number	:	757-867-5006

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY L EZEKIEL
Credential	:	DDS
Telephone Number	:	757-867-5003

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/07/2008

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