MEDICARE: DR. JAY F LEER 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	1223E0200X	Endodontics	11289	NC

General Provider Information

NPI Number	:	1629419130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY F LEER D.D.S.

Provider Business Mailing Address
First Line	:	322 DENTAL SCIENCE BLDG S
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1001
Country	:	US
Telephone Number	:	319-335-7440
Fax Number	:	319-335-7451

Provider Business Practice Location Address
First Line	:	2300 WAYNE MEMORIAL DR STE E
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1747
Country	:	US
Telephone Number	:	919-429-6056
Fax Number	:

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

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	09/25/2019

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