Provider Demographics
NPI:1336262385
Name:ZIBUTS, JUDITA (DDS)
Entity Type:Individual
Prefix:
First Name:JUDITA
Middle Name:
Last Name:ZIBUTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BROADWAY RM 2115
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-3051
Mailing Address - Country:US
Mailing Address - Phone:212-422-9229
Mailing Address - Fax:212-742-0928
Practice Address - Street 1:39 BROADWAY RM 2115
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3051
Practice Address - Country:US
Practice Address - Phone:212-422-9229
Practice Address - Fax:212-742-0928
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0528001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice