Healthcare Provider Details

I. General information

NPI: 1538397161
Provider Name (Legal Business Name): NEIL R ZACHS D.M.D, M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 02/28/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD STE 210
PHOENIX AZ
85050-4268
US

IV. Provider business mailing address

1598 BAY ST UNIT 204
SAN FRANCISCO CA
94123-1881
US

V. Phone/Fax

Practice location:
  • Phone: 480-538-8100
  • Fax:
Mailing address:
  • Phone: 480-394-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8371
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: