Provider Demographics
NPI:1649473968
Name:ZALLER, STUART TODD (DDS)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:TODD
Last Name:ZALLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136
Mailing Address - Country:US
Mailing Address - Phone:410-833-4880
Mailing Address - Fax:410-833-4896
Practice Address - Street 1:458 MAIN STREET
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136
Practice Address - Country:US
Practice Address - Phone:410-833-4880
Practice Address - Fax:410-833-4896
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice