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General NPI Number Information
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NPI Number | 1134631864
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Entity Type | Organization
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Legal Business Name | JENNY NEESE FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 11/03/2017
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Provider Practice Location Address
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Address Line | 6426 WHITESTOWN PKWY
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City | WHITESTOWN
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State | IN
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Zip | 46075-7604
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Country | US
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Telephone | 317-732-1800
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Fax | 317-647-3351
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Provider Business Mailing Address
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Address Line | 6426 WHITESTOWN PKWY
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City | WHITESTOWN
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State | IN
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Zip | 46075-7604
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Country | US
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Telephone | 317-732-1800
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Fax | 317-647-3351
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JENNIFER ASHLEY NEESE
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Credential | DDS
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Telephone | 317-732-1800
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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 | 12012134A
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License Number State | IN
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