Provider Demographics
NPI:1699827378
Name:ZELEZNOCK, JOHN ROBERT (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:ZELEZNOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S GEORGE STREET
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17405
Mailing Address - Country:US
Mailing Address - Phone:717-851-2066
Mailing Address - Fax:717-851-3565
Practice Address - Street 1:1001 S GEORGE STREET
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17405
Practice Address - Country:US
Practice Address - Phone:717-851-2066
Practice Address - Fax:717-851-3565
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015820L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0523924Medicaid
PA0523924Medicaid
PA0523924Medicare ID - Type Unspecified