Provider Demographics
NPI:1649631359
Name:ZASTROW DENTISTRY, LLC
Entity type:Organization
Organization Name:ZASTROW DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZASTROW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-766-7676
Mailing Address - Street 1:275 MAIN ST
Mailing Address - Street 2:#203
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-7805
Mailing Address - Country:US
Mailing Address - Phone:970-766-7676
Mailing Address - Fax:970-766-7680
Practice Address - Street 1:275 MAIN ST
Practice Address - Street 2:#203
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-7805
Practice Address - Country:US
Practice Address - Phone:970-766-7676
Practice Address - Fax:970-766-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4641223G0001X
CO81541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty