Provider Demographics
NPI:1073090817
Name:DURHAM DENTAL, PLLC
Entity Type:Organization
Organization Name:DURHAM DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-233-7492
Mailing Address - Street 1:360 MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-1644
Mailing Address - Country:US
Mailing Address - Phone:860-349-1123
Mailing Address - Fax:
Practice Address - Street 1:360 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-1644
Practice Address - Country:US
Practice Address - Phone:860-349-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty