Provider Demographics
NPI:1417294612
Name:ZACHAREWICZ, SHANE MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:MICHAEL
Last Name:ZACHAREWICZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHANE
Other - Middle Name:MICHAEL
Other - Last Name:ZACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1037 S STATE ROAD 7
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6138
Mailing Address - Country:US
Mailing Address - Phone:561-839-1802
Mailing Address - Fax:561-839-1803
Practice Address - Street 1:1037 S STATE ROAD 7
Practice Address - Street 2:SUITE 211
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6138
Practice Address - Country:US
Practice Address - Phone:561-839-1802
Practice Address - Fax:561-839-1803
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN185471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice