Provider Demographics
NPI:1750497764
Name:ZAX, MARCIA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:S
Last Name:ZAX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 KLINE RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-2303
Mailing Address - Country:US
Mailing Address - Phone:607-257-2687
Mailing Address - Fax:607-273-5940
Practice Address - Street 1:1301 TRUMANSBURG RD
Practice Address - Street 2:SUITE S
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1397
Practice Address - Country:US
Practice Address - Phone:607-273-5940
Practice Address - Fax:607-273-4625
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0395471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice