Active NPI
Mark S. Obernesser, D.D.S.,M.M.SC.
- Periodontics
- Fairlawn, OH
National Provider Identifier
1821077710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 21067
- Practice address
- 484 S Miller Rd
2ND Floor
Fairlawn, OH 44333-4176 - Phone
- (330) 867-3320
- Fax
- (330) 867-3339
- NPI assigned
- Jan 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 21067 | OH | Primary |
Addresses
Primary practice location
484 S Miller Rd
2ND Floor
Fairlawn, OH 44333-4176
Mailing address
484 S Miller Rd
2ND Floor
Fairlawn, OH 44333-4176
Phone (330) 867-3320
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 20, 2012 through Jul 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21067 | OH | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1821077710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "484 S MILLER RD",
"address_2": "2ND FLOOR",
"city": "FAIRLAWN",
"state": "OH",
"postal_code": "443334176",
"telephone_number": "330-867-3320",
"fax_number": "330-867-3339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "484 S MILLER RD",
"address_2": "2ND FLOOR",
"city": "FAIRLAWN",
"state": "OH",
"postal_code": "443334176",
"telephone_number": "330-867-3320",
"fax_number": "330-867-3339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBERNESSER",
"first_name": "MARK",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "D.D.S.,M.M.SC.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OH",
"license": "21067",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairlawn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.