Provider Demographics
NPI:1891869673
Name:ZYCK, JEFFREY STEWART (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEWART
Last Name:ZYCK
Suffix:
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 1:2360 ROUTE 100
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-3121
Mailing Address - Country:US
Mailing Address - Phone:610-398-2180
Mailing Address - Fax:610-398-1528
Practice Address - Street 1:2360 ROUTE 100
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-3121
Practice Address - Country:US
Practice Address - Phone:610-398-2180
Practice Address - Fax:610-398-1528
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031016L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist