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General NPI Number Information
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NPI Number | 1407292360
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Entity Type | Organization
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Legal Business Name | JENNIFER A. NEISE, D.D.S., P.C.
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 3132 W STATE ROAD 38
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City | PENDLETON
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State | IN
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Zip | 46064-8702
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Country | US
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Telephone | 765-778-7585
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Fax |
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Provider Business Mailing Address
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Address Line | 3132 W STATE ROAD 38
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City | PENDLETON
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State | IN
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Zip | 46064-8702
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Country | US
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Telephone | 765-778-7585
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JENNIFER NEISE
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Credential | D.D.S.
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Telephone | 765-778-7585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12010223A
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License Number State | IN
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