Provider Demographics
NPI:1013051689
Name:ZUFALL, JOSEPH P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:ZUFALL
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 1:1930 E ORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3553
Mailing Address - Country:US
Mailing Address - Phone:719-564-2842
Mailing Address - Fax:
Practice Address - Street 1:1930 E ORMAN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3553
Practice Address - Country:US
Practice Address - Phone:719-564-2842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51411223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02051415Medicaid
COU 09111Medicare UPIN
CO02051415Medicaid