MEDICARE: DR. JENEEN E LAPP 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	1223G0001X	General Practice Dentistry	30-019180	OH

General Provider Information

NPI Number	:	1700937554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENEEN E LAPP D.D.S.

Provider Business Mailing Address
First Line	:	807 E. WASHINGTON ST.
Second Line	:	SUITE 160
City	:	MEDINA
State	:	OH
Zip	:	44256
Country	:	US
Telephone Number	:	330-722-4506
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 E WASHINGTON ST
Second Line	:	SUITE 160
City	:	MEDINA
State	:	OH
Zip	:	44256-3338
Country	:	US
Telephone Number	:	330-722-4506
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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