Provider Demographics
NPI:1598931610
Name:VENZEL, JOHN MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MATTHEW
Last Name:VENZEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:37701 COLORADO AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2840
Mailing Address - Country:US
Mailing Address - Phone:440-934-2600
Mailing Address - Fax:440-934-2602
Practice Address - Street 1:37701 COLORADO AVE
Practice Address - Street 2:SUITE E
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011
Practice Address - Country:US
Practice Address - Phone:440-934-2600
Practice Address - Fax:440-934-2602
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH179511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0603716Medicaid
OH341769458026OtherCARE SOURCE
774120OtherUNITED CONCORDIA
1789396OtherTRICARE