MEDICARE: DR. MICHAEL L JARRELL DMD

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	DN12007	FL

General Provider Information

NPI Number	:	1912112541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL L JARRELL DMD

Provider Business Mailing Address
First Line	:	4327 US 1 S
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-7278
Country	:	US
Telephone Number	:	904-494-8630
Fax Number	:	904-494-6911

Provider Business Practice Location Address
First Line	:	1166 SW MAIN BLVD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-5780
Country	:	US
Telephone Number	:	386-752-7373
Fax Number	:	386-752-0056

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	10/10/2018

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