Provider Demographics
NPI:1609262443
Name:JENNIFER L ZOLL, DDS, LLC
Entity Type:Organization
Organization Name:JENNIFER L ZOLL, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ZOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-474-0733
Mailing Address - Street 1:3036 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4128
Mailing Address - Country:US
Mailing Address - Phone:419-474-0733
Mailing Address - Fax:419-474-5407
Practice Address - Street 1:3036 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4128
Practice Address - Country:US
Practice Address - Phone:419-474-0733
Practice Address - Fax:419-474-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184231223P0221X
OH0229541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0701520Medicaid
OH3116372Medicaid