MEDICARE: WILLIAM ZUCKER & KENNETH WYNESKI, DENTAL PARTNERS, INC.

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1407859150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM ZUCKER & KENNETH WYNESKI, DENTAL PARTNERS, INC.

Provider Business Mailing Address
First Line	:	3708 COLUMBUS AVE
Second Line	:	STE 10
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5776
Country	:	US
Telephone Number	:	419-686-8853
Fax Number	:	419-625-8023

Provider Business Practice Location Address
First Line	:	3708 COLUMBUS AVE
Second Line	:	STE 10
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5776
Country	:	US
Telephone Number	:	419-686-8853
Fax Number	:	419-625-8023

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM JOHN ZUCKER
Credential	:	DDS
Telephone Number	:	419-626-8853

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/22/2020

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