Provider Demographics
NPI:1093821159
Name:ZERVAS, THEODORE J (DMD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:J
Last Name:ZERVAS
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 1:55 FEDERAL ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2549
Mailing Address - Country:US
Mailing Address - Phone:413-772-0884
Mailing Address - Fax:413-773-7234
Practice Address - Street 1:55 FEDERAL ST
Practice Address - Street 2:SUITE 240
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2549
Practice Address - Country:US
Practice Address - Phone:413-772-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice