Provider Demographics
NPI:1669512497
Name:ZULCH, GEORGE D (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:ZULCH
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 1:728 N MAIN ST
Mailing Address - Street 2:REFUAH HEALTH CENTER
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1960
Mailing Address - Country:US
Mailing Address - Phone:845-354-9300
Mailing Address - Fax:845-354-9448
Practice Address - Street 1:728 N MAIN ST
Practice Address - Street 2:REFUAH HEALTH CENTER
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1960
Practice Address - Country:US
Practice Address - Phone:845-354-9300
Practice Address - Fax:845-354-9448
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01421705Medicaid