Provider Demographics
NPI:1417306606
Name:ZACK DOLLAR, DMD, LLC
Entity Type:Organization
Organization Name:ZACK DOLLAR, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:ZACHARY
Authorized Official - Last Name:DOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-362-3456
Mailing Address - Street 1:107 SPRING ST N
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2039
Mailing Address - Country:US
Mailing Address - Phone:256-362-3456
Mailing Address - Fax:256-761-0970
Practice Address - Street 1:107 SPRING ST N
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2039
Practice Address - Country:US
Practice Address - Phone:256-362-3456
Practice Address - Fax:256-761-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty