Provider Demographics
NPI:1265659346
Name:WAZNEY, ERICA MICHELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:MICHELLE
Last Name:WAZNEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32001 VINE STREET
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095
Mailing Address - Country:US
Mailing Address - Phone:440-944-3000
Mailing Address - Fax:440-944-0881
Practice Address - Street 1:32001 VINE STREET
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095
Practice Address - Country:US
Practice Address - Phone:440-944-3000
Practice Address - Fax:440-944-0881
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist