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NPI Code Detail

MEDICARE: JENIFER JO ZOBRO RDH

MEDICARE: JENIFER JO ZOBRO RDH
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
1124Q00000XDental Hygienist1002708-16WI

General Provider Information

NPI Number : 1104349703
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENIFER JO ZOBRO RDH
Provider Business Mailing Address
First Line : 2656 SOMAN CT
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-5564
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2280 W MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-4707
Country : US
Telephone Number : 920-321-3501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2017
Last Update Date : 07/25/2017

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