Provider Demographics
NPI:1609092238
Name:ZELLIN, NANCY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:ZELLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40255 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2149
Mailing Address - Country:US
Mailing Address - Phone:248-476-7711
Mailing Address - Fax:248-476-5891
Practice Address - Street 1:40255 GRAND RIVER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2149
Practice Address - Country:US
Practice Address - Phone:248-476-7711
Practice Address - Fax:248-476-5891
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist