Provider Demographics
NPI:1356459713
Name:ZAMBA, PHILLIP ALVIN (DMD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ALVIN
Last Name:ZAMBA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MERCHANT STREET
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2328
Mailing Address - Country:US
Mailing Address - Phone:724-266-1840
Mailing Address - Fax:724-266-1841
Practice Address - Street 1:1010 MERCHANT STREET
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2328
Practice Address - Country:US
Practice Address - Phone:724-266-1840
Practice Address - Fax:724-266-1841
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist