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NPI Code Detail

MEDICARE: MR. JAMES WALTER FENNELL D.D.S.

MEDICARE: MR. JAMES WALTER FENNELL 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
11223G0001XGeneral Practice Dentistry30-01-7059OH

General Provider Information

NPI Number : 1558389064
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES WALTER FENNELL D.D.S.
Provider Business Mailing Address
First Line : 1517 CHARLESTON LN
Second Line :
City : LOVELAND
State : OH
Zip : 45140-8020
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5451 MONTGOMERY RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-1708
Country : US
Telephone Number : 513-631-6600
Fax Number : 513-458-3492
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 07/08/2007

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