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NPI Code Detail

MEDICARE: DR. JEREMY S WANZER DDS

MEDICARE: DR. JEREMY S WANZER DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry30-021605OH

General Provider Information

NPI Number : 1194858126
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMY S WANZER DDS
Provider Business Mailing Address
First Line : 309 S CHAPEL ST
Second Line :
City : LOUISVILLE
State : OH
Zip : 44641-1612
Country : US
Telephone Number : 330-875-2200
Fax Number : 330-875-2403
Provider Business Practice Location Address
First Line : 309 S CHAPEL ST
Second Line :
City : LOUISVILLE
State : OH
Zip : 44641-1612
Country : US
Telephone Number : 330-875-2200
Fax Number : 330-875-2403
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 07/08/2007

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