Provider Demographics
NPI:1740490523
Name:ZASTROW, ELIZABETH ANNE (DDS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:ZASTROW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3039 LOCKPORT-OLCOTT ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108
Mailing Address - Country:US
Mailing Address - Phone:716-778-5150
Mailing Address - Fax:716-778-5105
Practice Address - Street 1:3039 LOCKPORT-OLCOTT ROAD
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108
Practice Address - Country:US
Practice Address - Phone:716-778-5150
Practice Address - Fax:716-778-5105
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04917211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice