Provider Demographics
NPI:1811171879
Name:THEODORE J. ZERVAS, DMD, LLC
Entity type:Organization
Organization Name:THEODORE J. ZERVAS, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZERVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-852-0089
Mailing Address - Street 1:484 MAIN ST STE 32
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2866
Mailing Address - Country:US
Mailing Address - Phone:860-852-0089
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN ST STE 32
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2866
Practice Address - Country:US
Practice Address - Phone:860-852-0089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental