Provider Demographics
NPI:1093002693
Name:ZEMLICKA, JERRY FRANK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:FRANK
Last Name:ZEMLICKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E 34TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4154
Mailing Address - Country:US
Mailing Address - Phone:907-274-7691
Mailing Address - Fax:907-277-6142
Practice Address - Street 1:625 E 34TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4154
Practice Address - Country:US
Practice Address - Phone:907-274-7691
Practice Address - Fax:907-277-6142
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice