Healthcare Provider Details

I. General information

NPI: 1952514010
Provider Name (Legal Business Name): TIM M ZNAMIROWSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

553 FREDERICK ST
SANTA CRUZ CA
95062-2635
US

IV. Provider business mailing address

553 FREDERICK ST
SANTA CRUZ CA
95062-2635
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-8001
  • Fax: 831-425-3563
Mailing address:
  • Phone: 831-425-8001
  • Fax: 831-425-3563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: