Provider Demographics
NPI:1073744041
Name:DAVID GROSSHANDLER, D.D.S. INC.
Entity Type:Organization
Organization Name:DAVID GROSSHANDLER, D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GROSSHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-453-9178
Mailing Address - Street 1:950 BETHESDA DR
Mailing Address - Street 2:BUILDING #5
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7507
Mailing Address - Country:US
Mailing Address - Phone:740-453-9178
Mailing Address - Fax:740-453-1631
Practice Address - Street 1:950 BETHESDA DR
Practice Address - Street 2:BUILDING #5
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7507
Practice Address - Country:US
Practice Address - Phone:740-453-9178
Practice Address - Fax:740-453-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0429692Medicaid