Provider Demographics
NPI:1821000969
Name:ZACHARCZENKO, NICHOLAS (DDS, MSD, RPH)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:ZACHARCZENKO
Suffix:
Gender:M
Credentials:DDS, MSD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WAYTO RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-2305
Mailing Address - Country:US
Mailing Address - Phone:518-399-1400
Mailing Address - Fax:
Practice Address - Street 1:28 CLINTON ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2143
Practice Address - Country:US
Practice Address - Phone:518-691-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0401751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics