Provider Demographics
NPI:1861912891
Name:BLEYER, JACOB SCOTT (DMD, MS)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:SCOTT
Last Name:BLEYER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3006 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8675
Mailing Address - Country:US
Mailing Address - Phone:636-978-8848
Mailing Address - Fax:636-294-4059
Practice Address - Street 1:3006 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8675
Practice Address - Country:US
Practice Address - Phone:636-978-8848
Practice Address - Fax:636-294-4059
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0030081223X0400X
MO20190148841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics