Provider Demographics
NPI:1417526443
Name:ZALDIVAR TEJADA, CARLOS FABRIZZIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:FABRIZZIO
Last Name:ZALDIVAR TEJADA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WALTER E FORAN BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4666
Mailing Address - Country:US
Mailing Address - Phone:908-788-1661
Mailing Address - Fax:908-284-0797
Practice Address - Street 1:4 WALTER E FORAN BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4666
Practice Address - Country:US
Practice Address - Phone:908-788-1661
Practice Address - Fax:908-284-0797
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028550001223G0001X
KS618981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice