MEDICARE: DR. NICHOLAS ZACHARCZENKO D.D.S., M.S.D., R.PH

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	1223P0700X	Prosthodontics	040175	NY

General Provider Information

NPI Number	:	1821000969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS ZACHARCZENKO D.D.S., M.S.D., R.PH

Provider Business Mailing Address
First Line	:	16 WAYTO RD
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-2305
Country	:	US
Telephone Number	:	518-399-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 CLINTON ST
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2143
Country	:	US
Telephone Number	:	518-691-0015
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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