Provider Demographics
NPI:1407292360
Name:JENNIFER A. NEISE, D.D.S., P.C.
Entity type:Organization
Organization Name:JENNIFER A. NEISE, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:NEISE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-778-7585
Mailing Address - Street 1:3132 W STATE ROAD 38
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-8702
Mailing Address - Country:US
Mailing Address - Phone:765-778-7585
Mailing Address - Fax:
Practice Address - Street 1:3132 W STATE ROAD 38
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-8702
Practice Address - Country:US
Practice Address - Phone:765-778-7585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IND12010223A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty