Provider Demographics
NPI:1972946242
Name:DENKA, ZACHARY (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:DENKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 S SMITHVILLE RD
Mailing Address - Street 2:DAYTON FAMILY PRACTICE ASSOC INC
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1500
Mailing Address - Country:US
Mailing Address - Phone:937-254-5661
Mailing Address - Fax:937-254-7367
Practice Address - Street 1:3328 S SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1500
Practice Address - Country:US
Practice Address - Phone:937-254-5661
Practice Address - Fax:937-254-7367
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.127612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0226956Medicaid