Provider Demographics
NPI:1083621221
Name:ZETZ, MICHAEL R JR (DMD, MS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:ZETZ
Suffix:JR
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 ISLAND PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8112
Mailing Address - Country:US
Mailing Address - Phone:843-278-1902
Mailing Address - Fax:
Practice Address - Street 1:899 ISLAND PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8112
Practice Address - Country:US
Practice Address - Phone:843-278-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC05921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics