Provider Demographics
NPI:1164622734
Name:STALLER, ZARINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZARINA
Middle Name:
Last Name:STALLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16950 JOG RD STE 106
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2353
Mailing Address - Country:US
Mailing Address - Phone:561-638-3007
Mailing Address - Fax:
Practice Address - Street 1:16950 JOG RD STE 106
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2353
Practice Address - Country:US
Practice Address - Phone:561-638-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist