Provider Demographics
NPI:1821077710
Name:OBERNESSER, MARK S (DDS,MMSC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:OBERNESSER
Suffix:
Gender:M
Credentials:DDS,MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 S MILLER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4176
Mailing Address - Country:US
Mailing Address - Phone:330-867-3320
Mailing Address - Fax:330-867-3339
Practice Address - Street 1:484 S MILLER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4176
Practice Address - Country:US
Practice Address - Phone:330-867-3320
Practice Address - Fax:330-867-3339
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH210671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics