Provider Demographics
NPI:1972656924
Name:ZUNDO, GEORGE RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RAYMOND
Last Name:ZUNDO
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 1:907 W FAIRCHILD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3710
Mailing Address - Country:US
Mailing Address - Phone:217-431-1440
Mailing Address - Fax:217-431-1977
Practice Address - Street 1:907 W FAIRCHILD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3710
Practice Address - Country:US
Practice Address - Phone:217-431-1440
Practice Address - Fax:217-431-1977
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice