Provider Demographics
NPI:1932303310
Name:OBERMEIER, JOSEPH R
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:OBERMEIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9299
Mailing Address - Country:US
Mailing Address - Phone:216-591-1161
Mailing Address - Fax:216-595-9300
Practice Address - Street 1:3401 RICHMOND RD STE 210
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4160
Practice Address - Country:US
Practice Address - Phone:216-591-1161
Practice Address - Fax:216-595-9300
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH192411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice