Provider Demographics
NPI:1679644009
Name:ZACCARIA, THOMAS M (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:ZACCARIA
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 1:67 DOWLIN FORGE ROAD
Mailing Address - Street 2:SUITE C LIONVILLE DENTAL ASSOCIATES LL6
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1548
Mailing Address - Country:US
Mailing Address - Phone:610-594-2001
Mailing Address - Fax:610-594-2077
Practice Address - Street 1:67 DOWLIN FORGE ROAD
Practice Address - Street 2:SUITE C LIONVILLE DENTAL ASSOCIATES LL6
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1548
Practice Address - Country:US
Practice Address - Phone:610-594-2001
Practice Address - Fax:610-594-2077
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017468L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101128677Medicaid
PA101128677Medicaid