Provider Demographics
NPI:1336502301
Name:ZYZO, JOHN CHARLES (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:ZYZO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:CHARLES
Other - Last Name:ZYZO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1430 JOHN WESLEY GILBERT DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0001
Mailing Address - Country:US
Mailing Address - Phone:706-721-2371
Mailing Address - Fax:706-721-6778
Practice Address - Street 1:1430 JOHN WESLEY GILBERT DRIVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0001
Practice Address - Country:US
Practice Address - Phone:706-721-2371
Practice Address - Fax:706-721-6778
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNF0004581223G0001X
CT118611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice