Provider Demographics
NPI:1982754339
Name:MEDVED, WILLIAM L (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:MEDVED
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 1:330 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3003
Mailing Address - Country:US
Mailing Address - Phone:740-653-9660
Mailing Address - Fax:740-653-8975
Practice Address - Street 1:330 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3003
Practice Address - Country:US
Practice Address - Phone:740-653-9660
Practice Address - Fax:740-653-8975
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH30200741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212577Medicaid