Provider Demographics
NPI:1164198305
Name:ZERVAS DENTISTRY PLLC
Entity Type:Organization
Organization Name:ZERVAS DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZERVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-834-1319
Mailing Address - Street 1:55 FEDERAL ST STE 240
Mailing Address - Street 2:
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 STE 240
Practice Address - Street 2:
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:413-773-7234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093821159OtherPROVIDER NPI