Provider Demographics
NPI:1649372293
Name:ZEMANOVICH, MARK ROY (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROY
Last Name:ZEMANOVICH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-5314
Mailing Address - Country:US
Mailing Address - Phone:540-868-2740
Mailing Address - Fax:
Practice Address - Street 1:203 SALEM CHURCH RD
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-5314
Practice Address - Country:US
Practice Address - Phone:540-868-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014111151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401411115OtherDENTAL LICENSE