Provider Demographics
NPI:1235575499
Name:TED D ZAHARAKO ESTATE
Entity Type:Organization
Organization Name:TED D ZAHARAKO ESTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL RESPENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-342-9986
Mailing Address - Street 1:431 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6757
Mailing Address - Country:US
Mailing Address - Phone:812-376-6676
Mailing Address - Fax:812-379-2498
Practice Address - Street 1:3154 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3170
Practice Address - Country:US
Practice Address - Phone:812-372-0102
Practice Address - Fax:812-372-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120074031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty