Provider Demographics
NPI:1922193580
Name:WAZNEY, MARION L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:L
Last Name:WAZNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29001 CEDAR ROAD
Mailing Address - Street 2:SUITE 680
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-461-1157
Mailing Address - Fax:440-461-1159
Practice Address - Street 1:29001 CEDAR ROAD
Practice Address - Street 2:SUITE 680
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-461-1157
Practice Address - Fax:440-461-1159
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0485596Medicaid
OH0485596Medicaid
OHT47863Medicare UPIN