Basic Information
| Provider Information | |||||||||
| NPI: | 1982991741 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENTES | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | GREGORY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MPH, D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5345 HENDRON RD | ||||||||
| Address2: | |||||||||
| City: | GROVEPORT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431251055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148350070 | ||||||||
| FaxNumber: | 6148350301 | ||||||||
| Practice Location | |||||||||
| Address1: | 5345 HENDRON RD | ||||||||
| Address2: | |||||||||
| City: | GROVEPORT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431251055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148350070 | ||||||||
| FaxNumber: | 6148350301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2011 | ||||||||
| LastUpdateDate: | 08/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34010998 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.