Provider Demographics
NPI:1770837288
Name:ZEN DENTAL
Entity Type:Organization
Organization Name:ZEN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZENAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:231-744-2387
Mailing Address - Street 1:650 HORTON ROAD
Mailing Address - Street 2:
Mailing Address - City:N. MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445
Mailing Address - Country:US
Mailing Address - Phone:231-744-2387
Mailing Address - Fax:
Practice Address - Street 1:650 HORTON ROAD
Practice Address - Street 2:
Practice Address - City:N. MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445
Practice Address - Country:US
Practice Address - Phone:231-744-2387
Practice Address - Fax:231-744-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902005276124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty