Provider Demographics
NPI:1124214523
Name:ZARZECKI, BENJAMIN LEO (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEO
Last Name:ZARZECKI
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:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:EVART
Mailing Address - State:MI
Mailing Address - Zip Code:49631-0687
Mailing Address - Country:US
Mailing Address - Phone:231-734-5621
Mailing Address - Fax:231-734-5851
Practice Address - Street 1:120 N PINE ST
Practice Address - Street 2:
Practice Address - City:EVART
Practice Address - State:MI
Practice Address - Zip Code:49631-5120
Practice Address - Country:US
Practice Address - Phone:231-734-5621
Practice Address - Fax:231-734-5851
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist