Provider Demographics
NPI:1659824944
Name:ZOLLER, DESMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:DESMOND
Middle Name:
Last Name:ZOLLER
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 1:1634 YORK RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1033
Mailing Address - Country:US
Mailing Address - Phone:719-522-0800
Mailing Address - Fax:
Practice Address - Street 1:1634 YORK RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1033
Practice Address - Country:US
Practice Address - Phone:719-522-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist