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General NPI Number Information
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NPI Number | 1356837512
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Entity Type | Organization
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Legal Business Name | JENNIFER LONNEN DDS PLLC
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 6221 RT 31 STE 102
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City | CICERO
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State | NY
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Zip | 13039
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Country | US
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Telephone | 315-699-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 6221 RT 31 STE 102
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City | CICERO
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State | NY
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Zip | 13039
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Country | US
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Telephone | 315-699-1919
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER LONNEN
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Credential | DDS
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Telephone | 315-699-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 058612
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License Number State | NY
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