Provider Demographics
NPI:1558708628
Name:ZONE, MARTIN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:P
Last Name:ZONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:2288 ROUTE 63
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-0548
Mailing Address - Country:US
Mailing Address - Phone:585-728-5200
Mailing Address - Fax:
Practice Address - Street 1:2288 ROUTE 63
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-0548
Practice Address - Country:US
Practice Address - Phone:585-728-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01054695Medicaid