Provider Demographics
NPI:1982710323
Name:GROSSHANDLER, MARK H (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:GROSSHANDLER
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 1:830 BETHESDA DR
Mailing Address - Street 2:BLDG 1
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-454-9961
Mailing Address - Fax:740-454-1670
Practice Address - Street 1:830 BETHESDA DR
Practice Address - Street 2:BLDG 1
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1895
Practice Address - Country:US
Practice Address - Phone:740-454-9961
Practice Address - Fax:740-454-1670
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0199968Medicaid