Healthcare Provider Details

I. General information

NPI: 1457573669
Provider Name (Legal Business Name): R. JASON SCHNEPF DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 N BROAD ST
GRIFFITH IN
46319-2223
US

IV. Provider business mailing address

423 N BROAD ST
GRIFFITH IN
46319-2223
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-7870
  • Fax: 219-922-8056
Mailing address:
  • Phone: 219-922-7870
  • Fax: 219-922-8056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010464A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. R JASON SCHNEPF
Title or Position: DENTIST
Credential: DDS
Phone: 219-922-7870