Provider Demographics
NPI:1992009245
Name:ZANESVILLE DENTAL LLC
Entity Type:Organization
Organization Name:ZANESVILLE DENTAL LLC
Other - Org Name:SCOTT E WLLIAMS DDS AND T ANDREW FUHRIMAN DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-454-1167
Mailing Address - Street 1:1100 BRANDYWINE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7303
Mailing Address - Country:US
Mailing Address - Phone:740-454-1167
Mailing Address - Fax:
Practice Address - Street 1:1100 BRANDYWINE BLVD STE C
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7303
Practice Address - Country:US
Practice Address - Phone:740-454-1167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19202122300000X
OH21909122300000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty