Provider Demographics
NPI:1861033250
Name:ZAMBOS, DENNIS A
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:A
Last Name:ZAMBOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 MECHANICSVILLE TPKE UNIT 683
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1281
Mailing Address - Country:US
Mailing Address - Phone:813-293-6767
Mailing Address - Fax:
Practice Address - Street 1:11322 AIR PARK RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-3438
Practice Address - Country:US
Practice Address - Phone:813-293-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA67195667172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty