Provider Demographics
NPI:1669674115
Name:ZAMAT, MARK LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEE
Last Name:ZAMAT
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 1:129 WOODBINE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1448
Mailing Address - Country:US
Mailing Address - Phone:203-372-8673
Mailing Address - Fax:
Practice Address - Street 1:1200 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5835
Practice Address - Country:US
Practice Address - Phone:203-378-0182
Practice Address - Fax:203-378-3016
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice