Provider Demographics
NPI:1134147770
Name:ZATS, BORIS (DDS, FADSA)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:ZATS
Suffix:
Gender:M
Credentials:DDS, FADSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3906
Mailing Address - Country:US
Mailing Address - Phone:718-743-5400
Mailing Address - Fax:718-743-4125
Practice Address - Street 1:1918 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3906
Practice Address - Country:US
Practice Address - Phone:718-743-5400
Practice Address - Fax:718-743-4125
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0493751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02598878Medicaid