Healthcare Provider Details

I. General information

NPI: 1417931114
Provider Name (Legal Business Name): RALPH STEPHEN ZOTOVICH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N JACKSON AVE SUITE 110
SAN JOSE CA
95116-1908
US

IV. Provider business mailing address

150 N JACKSON AVE SUITE 110
SAN JOSE CA
95116-1908
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-1133
  • Fax: 408-259-3555
Mailing address:
  • Phone: 408-259-1133
  • Fax: 408-259-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number24420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: