Provider Demographics
NPI:1508915752
Name:MATTHEW L ZIZMOR DDS PC
Entity Type:Organization
Organization Name:MATTHEW L ZIZMOR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZIZMOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-738-4788
Mailing Address - Street 1:1244 BOYLSTON STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467
Mailing Address - Country:US
Mailing Address - Phone:617-738-4788
Mailing Address - Fax:617-735-0031
Practice Address - Street 1:1244 BOYLSTON STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467
Practice Address - Country:US
Practice Address - Phone:617-738-4788
Practice Address - Fax:617-735-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA137811223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA544958OtherUNITED CORNCORDIA