MEDICARE: SOUTH COURT DENTAL MEDICINE, INC. -JEFFREY C ESTERBURG D.M.D. AND MICH

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

General Provider Information

NPI Number	:	1588757470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COURT DENTAL MEDICINE, INC. -JEFFREY C ESTERBURG D.M.D. AND MICH

Provider Business Mailing Address
First Line	:	1063 S COURT ST
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-2824
Country	:	US
Telephone Number	:	330-725-0581
Fax Number	:	330-722-0146

Provider Business Practice Location Address
First Line	:	1063 S COURT ST
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-2824
Country	:	US
Telephone Number	:	330-725-0581
Fax Number	:	330-722-0146

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY C ESTERBURG
Credential	:	D.M.D.
Telephone Number	:	330-725-0581

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/22/2020

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