Healthcare Provider Details

I. General information

NPI: 1083610463
Provider Name (Legal Business Name): JENNIFER L. ZOLL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3036 W SYLVANIA AVE
TOLEDO OH
43613-4128
US

IV. Provider business mailing address

3036 W SYLVANIA AVE
TOLEDO OH
43613-4128
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-0733
  • Fax: 419-474-5407
Mailing address:
  • Phone: 419-474-0733
  • Fax: 419-474-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number18423
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: