Provider Demographics
NPI:1932886819
Name:ZOLOTCO, IVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:ZOLOTCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ION
Other - Middle Name:
Other - Last Name:ZOLOTCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2316 N WAHSATCH AVE # 374
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9348 GRAND CORDERA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7006
Practice Address - Country:US
Practice Address - Phone:719-722-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205560122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice