Healthcare Provider Details

I. General information

NPI: 1528416823
Provider Name (Legal Business Name): JACOB VENOY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31891 STATE ROUTE 93 N
MCARTHUR OH
45651
US

IV. Provider business mailing address

1049 WESTERN AVE P.O. BOX 188
CHILLICOTHEE OH
45601-1104
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-4366
  • Fax: 740-775-7855
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-775-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.24759
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: