Provider Demographics
NPI:1689757585
Name:ZAJAC, ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:ZAJAC
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 1:890 RICHARD RD
Mailing Address - Street 2:STE B
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1779
Mailing Address - Country:US
Mailing Address - Phone:219-322-1326
Mailing Address - Fax:219-322-9986
Practice Address - Street 1:890 RICHARD RD
Practice Address - Street 2:STE B
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1779
Practice Address - Country:US
Practice Address - Phone:219-322-1326
Practice Address - Fax:219-322-9986
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist