Provider Demographics
NPI:1073635595
Name:ZULLO, RICHARD S (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:ZULLO
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 1:1385 W STATE ROAD 434
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6871
Mailing Address - Country:US
Mailing Address - Phone:407-332-6060
Mailing Address - Fax:407-332-8190
Practice Address - Street 1:1385 W STATE ROAD 434
Practice Address - Street 2:SUITE 203
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6871
Practice Address - Country:US
Practice Address - Phone:407-332-6060
Practice Address - Fax:407-332-8190
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist