Provider Demographics
NPI:1124603725
Name:DANIEL S ZUPSANSKY DDS, LEE T HARTZLER DDS, & TYLER A OVERMYER DDS INC
Entity Type:Organization
Organization Name:DANIEL S ZUPSANSKY DDS, LEE T HARTZLER DDS, & TYLER A OVERMYER DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTZLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-465-1460
Mailing Address - Street 1:567 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-3400
Mailing Address - Country:US
Mailing Address - Phone:330-262-0206
Mailing Address - Fax:330-262-3809
Practice Address - Street 1:567 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3400
Practice Address - Country:US
Practice Address - Phone:330-262-0206
Practice Address - Fax:330-262-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1245758226OtherTYLER A. OVERMYER
OH1922410810OtherLEE T. HARTZLER
OH1306984224OtherDANIEL S. ZUPSANSKY