Provider Demographics
NPI:1386664282
Name:ZINSER, PHILIP J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:ZINSER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0095
Mailing Address - Country:US
Mailing Address - Phone:575-464-0734
Mailing Address - Fax:575-464-0734
Practice Address - Street 1:MESCALERO IHS INDIAN HOSPITAL
Practice Address - Street 2:318 ABALONE LOOP
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340
Practice Address - Country:US
Practice Address - Phone:575-464-3831
Practice Address - Fax:575-464-4422
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN102111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice