Provider Demographics
NPI:1669548871
Name:ZEMAN, MARK SAMUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:SAMUEL
Last Name:ZEMAN
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 1:103 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2400
Mailing Address - Country:US
Mailing Address - Phone:770-887-0447
Mailing Address - Fax:770-887-9521
Practice Address - Street 1:103 MOUNTAIN VIEW DR
Practice Address - Street 2:SUITE A
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2400
Practice Address - Country:US
Practice Address - Phone:770-887-0447
Practice Address - Fax:770-887-9521
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice