Provider Demographics
NPI:1760687206
Name:MARION L. WAZNEY D.D.S. INC.
Entity Type:Organization
Organization Name:MARION L. WAZNEY D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-461-1157
Mailing Address - Street 1:29001 CEDAR RD
Mailing Address - Street 2:SUITE 680
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4062
Mailing Address - Country:US
Mailing Address - Phone:440-461-1157
Mailing Address - Fax:440-461-1159
Practice Address - Street 1:29001 CEDAR RD
Practice Address - Street 2:SUITE 680
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4062
Practice Address - Country:US
Practice Address - Phone:440-461-1157
Practice Address - Fax:440-461-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0485596Medicaid
OH0485596Medicaid
OHMA0534312Medicare ID - Type Unspecified