Provider Demographics
NPI:1043240856
Name:ZERNICKE, ROBERT PATRICK (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PATRICK
Last Name:ZERNICKE
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 1:271 RESERVATION ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933
Mailing Address - Country:US
Mailing Address - Phone:831-384-7730
Mailing Address - Fax:831-384-3329
Practice Address - Street 1:271 RESERVATION ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933
Practice Address - Country:US
Practice Address - Phone:831-384-7730
Practice Address - Fax:831-384-3329
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist