Healthcare Provider Details

I. General information

NPI: 1063626505
Provider Name (Legal Business Name): WILLARD EMERY ZURCHER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 PENNSYLVANIA AVE
FAIRFIELD CA
94533
US

IV. Provider business mailing address

1900 PENNSYLVANIA AVE
FAIRFIELD CA
94533
US

V. Phone/Fax

Practice location:
  • Phone: 707-427-1010
  • Fax: 707-427-1149
Mailing address:
  • Phone: 707-427-1010
  • Fax: 707-427-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22191
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0201307010
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: