Healthcare Provider Details

I. General information

NPI: 1801713938
Provider Name (Legal Business Name): JENIFFER LACAYO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 LOOMIS LN
LIBERTY TOWNSHIP OH
45069-3898
US

IV. Provider business mailing address

8100 NASH CIR
LIBERTY TOWNSHIP OH
45069-6683
US

V. Phone/Fax

Practice location:
  • Phone: 513-506-0762
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028582
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: