MEDICARE: DR. JAY B REESE 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	1223G0001X	General Practice Dentistry	015466	MO

General Provider Information

NPI Number	:	1700865227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY B REESE D.D.S.

Provider Business Mailing Address
First Line	:	2001 CORONA RD
Second Line	:	SUITE 301
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5924
Country	:	US
Telephone Number	:	573-446-8000
Fax Number	:	573-446-8080

Provider Business Practice Location Address
First Line	:	2001 CORONA RD
Second Line	:	SUITE 301
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5924
Country	:	US
Telephone Number	:	573-446-8000
Fax Number	:	573-446-8080

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	07/08/2007

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