Healthcare Provider Details

I. General information

NPI: 1285803833
Provider Name (Legal Business Name): ROGER H ZIERENBERG JR. DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 LOMBARD ST SUITE 5
THOUSAND OAKS CA
91360-5830
US

IV. Provider business mailing address

250 LOMBARD ST SUITE 5
THOUSAND OAKS CA
91360-5830
US

V. Phone/Fax

Practice location:
  • Phone: 805-495-5474
  • Fax:
Mailing address:
  • Phone: 805-495-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number24627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: