Jacob Scott Bleyer, DMD, MS
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · O'Fallon, MO
NPI 1861912891 · NPPES record last updated Mar 25, 2024
Key facts
- NPI
- 1861912891
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 2019014884 (MO)
- Practice address
- 3006 Highway K
O'Fallon, MO 63368-8675 - Phone
- (636) 978-8848
- Fax
- (636) 294-4059
- NPI assigned
- Jun 21, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021.003008 | IL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| 2019014884 | MO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bankhead Alton Orthodontics PC | Orthodontics and Dentofacial Orthopedics | Past |
Accepting new patients |
| Wentzville Orthodontics | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 021.003008 | IL | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2019014884 | MO | Yes |
Addresses
Primary practice location
3006 Highway K
O'Fallon, MO 63368-8675
Mailing address
3006 Highway K
O'Fallon, MO 63368-8675
Phone (636) 978-8848
Other providers in O'Fallon, MO
- Matthew A Beckerdite
- Danielle R Berra
- Sarah Biondo
- Sara Birkemeier
- Terry Michael Blake
- Michael Kenneth Brown
- Jill Buery
- Marianna Burkemper
- Bess M Cain
- Cardinal Home Care LLC
All providers in O'Fallon, MO · Orthodontics and Dentofacial Orthopedics Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.