Provider Demographics
NPI:1932494903
Name:ZAHNER, JOHATHAN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHATHAN
Middle Name:A
Last Name:ZAHNER
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 1:3 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3317
Mailing Address - Country:US
Mailing Address - Phone:860-870-9031
Mailing Address - Fax:860-871-2964
Practice Address - Street 1:3 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3317
Practice Address - Country:US
Practice Address - Phone:860-870-9031
Practice Address - Fax:860-871-2964
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT105411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice