Provider Demographics
NPI:1437613320
Name:JACK ZAZZARO DMD LLC
Entity Type:Organization
Organization Name:JACK ZAZZARO DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROULANAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-264-0244
Mailing Address - Street 1:316 MAIN ST S STE D
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4238
Mailing Address - Country:US
Mailing Address - Phone:203-264-0244
Mailing Address - Fax:203-264-5299
Practice Address - Street 1:316 MAIN ST S STE D
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4238
Practice Address - Country:US
Practice Address - Phone:203-264-0244
Practice Address - Fax:203-264-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty