MEDICARE: DR. JEFFREY JENNINGS EBERTING D.M.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS0000007906	TN

General Provider Information

NPI Number	:	1649268814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY JENNINGS EBERTING D.M.D.

Provider Business Mailing Address
First Line	:	619 SMITHVIEW DR
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-6100
Country	:	US
Telephone Number	:	865-983-3570
Fax Number	:	865-983-9547

Provider Business Practice Location Address
First Line	:	619 SMITHVIEW DR
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-6100
Country	:	US
Telephone Number	:	865-983-3570
Fax Number	:	865-983-9547

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/08/2007

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