Provider Demographics
NPI:1790048668
Name:MICHAEL R. ZARITSKY, DDS, PLLC
Entity Type:Organization
Organization Name:MICHAEL R. ZARITSKY, DDS, PLLC
Other - Org Name:OUTER BANKS ORAL SURGERY AND IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ZARITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-699-4648
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-0512
Mailing Address - Country:US
Mailing Address - Phone:252-261-1313
Mailing Address - Fax:252-261-1335
Practice Address - Street 1:5107 N CROATAN HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3989
Practice Address - Country:US
Practice Address - Phone:252-261-1313
Practice Address - Fax:252-261-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917735Medicaid