Healthcare Provider Details

I. General information

NPI: 1700899184
Provider Name (Legal Business Name): MICHAEL STEWART ZOLA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 GAYLEY AVE SUITE 115
LOS ANGELES CA
90024-3417
US

IV. Provider business mailing address

1033 GAYLEY AVE SUITE 115
LOS ANGELES CA
90024-3417
US

V. Phone/Fax

Practice location:
  • Phone: 310-208-4036
  • Fax: 310-208-1344
Mailing address:
  • Phone: 310-208-4036
  • Fax: 310-208-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number034250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: