Provider Demographics
NPI:1457413304
Name:ZASLAVSKY, MAX ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:ANDREW
Last Name:ZASLAVSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22509 MIDDLETOWN DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4713
Mailing Address - Country:US
Mailing Address - Phone:561-445-3619
Mailing Address - Fax:
Practice Address - Street 1:6451 N FEDERAL HWY
Practice Address - Street 2:STE. 129
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1402
Practice Address - Country:US
Practice Address - Phone:954-491-3544
Practice Address - Fax:954-491-3562
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist