MEDICARE: R. JASON SCHNEPF 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	1223G0001X	General Practice Dentistry	12010464A	IN

General Provider Information

NPI Number	:	1457573669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R. JASON SCHNEPF DDS

Provider Business Mailing Address
First Line	:	423 N BROAD ST
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-2223
Country	:	US
Telephone Number	:	219-922-7870
Fax Number	:	219-922-8056

Provider Business Practice Location Address
First Line	:	423 N BROAD ST
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-2223
Country	:	US
Telephone Number	:	219-922-7870
Fax Number	:	219-922-8056

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. R JASON SCHNEPF
Credential	:	DDS
Telephone Number	:	219-922-7870

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	09/25/2007

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