Provider Demographics
NPI:1932339512
Name:HUNTZINGER, ANDREW MARSHALL (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARSHALL
Last Name:HUNTZINGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 SYLVAN LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-8701
Mailing Address - Country:US
Mailing Address - Phone:419-882-4510
Mailing Address - Fax:419-885-3771
Practice Address - Street 1:3924 SYLVAN LAKES BLVD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-8701
Practice Address - Country:US
Practice Address - Phone:419-882-4510
Practice Address - Fax:419-885-3771
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist