Provider Demographics
NPI:1689010530
Name:ZYSK, JENNIFER JOY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOY
Last Name:ZYSK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HURLEY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-2134
Mailing Address - Country:US
Mailing Address - Phone:617-491-1403
Mailing Address - Fax:
Practice Address - Street 1:77 HURLEY ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-2134
Practice Address - Country:US
Practice Address - Phone:617-491-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist