Provider Demographics
NPI:1295047066
Name:VIACHESLAV S. ZOUBTSOV,D.D.S.,A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:VIACHESLAV S. ZOUBTSOV,D.D.S.,A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIACHESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOUBTSOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-201-6278
Mailing Address - Street 1:2636 GREENBOROUGH PL
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1049 W PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6145
Practice Address - Country:US
Practice Address - Phone:909-391-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty