Provider Demographics
NPI:1801002365
Name:ZEBRACK, ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:ZEBRACK
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 1:12840 RIVERSIDE DR STE 406
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3351
Mailing Address - Country:US
Mailing Address - Phone:818-763-9701
Mailing Address - Fax:818-763-5542
Practice Address - Street 1:12840 RIVERSIDE DR STE 406
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-3351
Practice Address - Country:US
Practice Address - Phone:818-763-9701
Practice Address - Fax:818-763-5542
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist