MEDICARE: DR. JENNIFER L. ZOLL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	18423	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	341817921	OTHER	OH	FED TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083610463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER L. ZOLL D.D.S.

Provider Business Mailing Address
First Line	:	3036 W SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-4128
Country	:	US
Telephone Number	:	419-474-0733
Fax Number	:	419-474-5407

Provider Business Practice Location Address
First Line	:	3036 W SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-4128
Country	:	US
Telephone Number	:	419-474-0733
Fax Number	:	419-474-5407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	04/02/2012

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