MEDICARE: DR. JACOB T. FLYTE DDS

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	122300000X	Dentist	2901600961	MI

General Provider Information

NPI Number	:	1831767631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB T. FLYTE DDS

Provider Business Mailing Address
First Line	:	2312 CHELSEA LN APT 207
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-8841
Country	:	US
Telephone Number	:	248-804-6903
Fax Number	:

Provider Business Practice Location Address
First Line	:	5217 N ROYAL DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7827
Country	:	US
Telephone Number	:	231-929-3606
Fax Number	:

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

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	03/03/2022

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