MEDICARE: DR. 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	122300000X	Dentist	12010464A	IN

General Provider Information

NPI Number	:	1518031590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. R JASON SCHNEPF DDS

Provider Business Mailing Address
First Line	:	647 W BUENA AVE
Second Line	:	3E
City	:	CHICAGO
State	:	IL
Zip	:	60613-2278
Country	:	US
Telephone Number	:	219-951-2188
Fax Number	:

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	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/09/2007

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