Provider Demographics
NPI:1396182523
Name:ZIETSMAN, CHRISTIAAN FREDERICK (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTIAAN
Middle Name:FREDERICK
Last Name:ZIETSMAN
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 1:30 LANDING AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2711
Mailing Address - Country:US
Mailing Address - Phone:631-265-6900
Mailing Address - Fax:
Practice Address - Street 1:30 LANDING AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2711
Practice Address - Country:US
Practice Address - Phone:631-265-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058907-11223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics