Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 18423 | OH |
NPI | 1083610463 |
---|---|
Provider Name | Dr. Jennifer L. Zoll |
First Address | Toledo, OH 43613-4128 |
Second Address | Toledo, OH 43613-4128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 02/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0701520 | (05) | OH |
341817921 | FED TAX ID (01) | OH |