Provider Demographics
NPI:1891750683
Name:ZANAKOS, NICHOLAS M JR (DMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:M
Last Name:ZANAKOS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 W BOY SCOUT BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5796
Mailing Address - Country:US
Mailing Address - Phone:813-288-6264
Mailing Address - Fax:813-289-7549
Practice Address - Street 1:4161 TAMIAMI TRL STE 604
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9283
Practice Address - Country:US
Practice Address - Phone:941-255-8500
Practice Address - Fax:941-255-8503
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN140101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071320100Medicaid
FL071320100Medicaid