Provider Demographics
NPI:1811462732
Name:ZINZUVADIA, KUSHAL G (DMD)
Entity type:Individual
Prefix:
First Name:KUSHAL
Middle Name:G
Last Name:ZINZUVADIA
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 1:162 SAINT BOTOLPH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5118
Mailing Address - Country:US
Mailing Address - Phone:857-272-5494
Mailing Address - Fax:
Practice Address - Street 1:162 SAINT BOTOLPH ST APT 10
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5118
Practice Address - Country:US
Practice Address - Phone:857-272-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-07
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist