Provider Demographics
NPI:1457573669
Name:R. JASON SCHNEPF DDS
Entity Type:Organization
Organization Name:R. JASON SCHNEPF DDS
Other - Org Name:BROAD SMILE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:SCHNEPF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-922-7870
Mailing Address - Street 1:423 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2223
Mailing Address - Country:US
Mailing Address - Phone:219-922-7870
Mailing Address - Fax:219-922-8056
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:219-922-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010464A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty