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General NPI Number Information
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NPI Number | 1124213962
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Entity Type | Organization
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Legal Business Name | JEFFREY W RHONEMUS,D.D.S.,P.C.
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 302 S FAIRGROUND ST
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City | LIBERTY
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State | IN
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Zip | 47353-1414
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Country | US
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Telephone | 765-458-5618
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Fax | 765-458-6734
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Provider Business Mailing Address
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Address Line | 302 S FAIRGROUND ST
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City | LIBERTY
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State | IN
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Zip | 47353-1414
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Country | US
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Telephone | 765-458-5618
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Fax | 765-458-6734
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Authorized Official
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Title or Position | PRES
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Name | DR. JEFFREY WILLIAM RHONEMUS
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Credential | DDS
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Telephone | 765-458-5618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 54001205
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License Number State | IN
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