Healthcare Provider Details

I. General information

NPI: 1992009245
Provider Name (Legal Business Name): ZANESVILLE DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BRANDYWINE BLVD STE C
ZANESVILLE OH
43701-7303
US

IV. Provider business mailing address

1100 BRANDYWINE BLVD STE C
ZANESVILLE OH
43701-7303
US

V. Phone/Fax

Practice location:
  • Phone: 740-454-1167
  • Fax:
Mailing address:
  • Phone: 740-454-1167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19202
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number21909
License Number StateOH

VIII. Authorized Official

Name: SCOTT E WILLIAMS
Title or Position: PARTNER
Credential: DDS
Phone: 740-454-1167