MEDICARE: RYAN ZLOTKOWSKI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22D102289100	NJ

General Provider Information

NPI Number	:	1700917127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN ZLOTKOWSKI DMD

Provider Business Mailing Address
First Line	:	435 RINGWOOD AVE
Second Line	:
City	:	POMPTON LAKES
State	:	NJ
Zip	:	07442-2208
Country	:	US
Telephone Number	:	973-835-0702
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 RINGWOOD AVE
Second Line	:
City	:	POMPTON LAKES
State	:	NJ
Zip	:	07442-2208
Country	:	US
Telephone Number	:	973-835-0702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/04/2009

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