Provider Demographics
NPI:1407965239
Name:ZITTERBART, PAUL ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
Last Name:ZITTERBART
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 1:56 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1005
Mailing Address - Country:US
Mailing Address - Phone:317-852-8194
Mailing Address - Fax:
Practice Address - Street 1:3838 N RURAL ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2930
Practice Address - Country:US
Practice Address - Phone:317-221-2306
Practice Address - Fax:317-221-2336
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007916A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice