Provider Demographics
NPI:1164637211
Name:EDWARD R. ZANCA D.M.D., P.A.
Entity Type:Organization
Organization Name:EDWARD R. ZANCA D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZANCA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-236-4356
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-1107
Mailing Address - Country:US
Mailing Address - Phone:207-236-4356
Mailing Address - Fax:207-236-0934
Practice Address - Street 1:5 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5746
Practice Address - Country:US
Practice Address - Phone:207-236-4356
Practice Address - Fax:207-236-0934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME27131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty