Provider Demographics
NPI:1629190541
Name:ZELAZNY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ZELAZNY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ZELAZNY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-627-0215
Mailing Address - Street 1:10128 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-6514
Mailing Address - Country:US
Mailing Address - Phone:804-627-0215
Mailing Address - Fax:804-627-0217
Practice Address - Street 1:10128 BROOK RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-6514
Practice Address - Country:US
Practice Address - Phone:804-627-0215
Practice Address - Fax:804-627-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088741223G0001X
VA04010088901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty