Provider Demographics
NPI:1891809224
Name:ZUPANCIC, JOHN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:ZUPANCIC
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 1:1515 E 25TH ST
Mailing Address - Street 2:C-153
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3354
Mailing Address - Country:US
Mailing Address - Phone:218-263-2916
Mailing Address - Fax:218-263-2971
Practice Address - Street 1:1515 E 25TH ST
Practice Address - Street 2:C-153
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-3354
Practice Address - Country:US
Practice Address - Phone:218-263-2916
Practice Address - Fax:218-263-2971
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN107001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41-1444305OtherEIN