Provider Demographics
NPI:1518031590
Name:SCHNEPF, R JASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:JASON
Last Name:SCHNEPF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 W BUENA AVE
Mailing Address - Street 2:3E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2278
Mailing Address - Country:US
Mailing Address - Phone:219-951-2188
Mailing Address - Fax:
Practice Address - Street 1:423 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2223
Practice Address - Country:US
Practice Address - Phone:219-922-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010464A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist