Provider Demographics
NPI:1477673648
Name:DZUBAN, JOHN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:DZUBAN
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 1:300 PENN CENTER BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5502
Mailing Address - Country:US
Mailing Address - Phone:412-825-0200
Mailing Address - Fax:412-825-4627
Practice Address - Street 1:300 PENN CENTER BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5502
Practice Address - Country:US
Practice Address - Phone:412-825-0200
Practice Address - Fax:412-825-4627
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026891332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies