Provider Demographics
NPI:1114361193
Name:JACOB ZUNIGA,DDS,LLC
Entity Type:Organization
Organization Name:JACOB ZUNIGA,DDS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-539-7323
Mailing Address - Street 1:33 N LINDSAY RD
Mailing Address - Street 2:SUITE101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5807
Mailing Address - Country:US
Mailing Address - Phone:480-539-7323
Mailing Address - Fax:480-539-2968
Practice Address - Street 1:33 N LINDSAY RD
Practice Address - Street 2:SUITE101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5807
Practice Address - Country:US
Practice Address - Phone:480-539-7323
Practice Address - Fax:480-539-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty