Healthcare Provider Details

I. General information

NPI: 1609262443
Provider Name (Legal Business Name): JENNIFER L ZOLL, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 04/08/2015
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 TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number022954
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number18423
License Number StateOH

VIII. Authorized Official

Name: DR. JENNIFER LYNN ZOLL
Title or Position: OWNER
Credential: DDS
Phone: 419-474-0733