MEDICARE: JACOB MYERS, DDS, PLLC

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	1223P0221X	Pediatric Dentistry	20163	MI

General Provider Information

NPI Number	:	1578963237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB MYERS, DDS, PLLC

Provider Business Mailing Address
First Line	:	2121 ABBOT RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8535
Country	:	US
Telephone Number	:	517-337-0032
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 ABBOT RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8535
Country	:	US
Telephone Number	:	517-337-0032
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACOB E MYERS
Credential	:	DDS
Telephone Number	:	517-337-0032

Provider Enumeration Date	:	09/01/2014
Last Update Date	:	09/01/2014

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