MEDICARE: JESS SHIRLEY PLUMMER 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	KS5905	KS

General Provider Information

NPI Number	:	1982714531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESS SHIRLEY PLUMMER D.D.S.

Provider Business Mailing Address
First Line	:	535 S MAIN ST
Second Line	:
City	:	EL DORADO
State	:	KS
Zip	:	67042-3517
Country	:	US
Telephone Number	:	316-321-4222
Fax Number	:	316-321-3840

Provider Business Practice Location Address
First Line	:	535 S MAIN ST
Second Line	:
City	:	EL DORADO
State	:	KS
Zip	:	67042-3517
Country	:	US
Telephone Number	:	316-321-4222
Fax Number	:	316-321-3840

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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