Provider Demographics
NPI:1770211583
Name:J B ZOUTENDAM DDS PC
Entity type:Organization
Organization Name:J B ZOUTENDAM DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOUTENDAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-946-6336
Mailing Address - Street 1:535 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3423
Mailing Address - Country:US
Mailing Address - Phone:231-946-6336
Mailing Address - Fax:231-946-9489
Practice Address - Street 1:535 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3423
Practice Address - Country:US
Practice Address - Phone:231-946-6336
Practice Address - Fax:231-946-9489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental