Healthcare Provider Details

I. General information

NPI: 1972013639
Provider Name (Legal Business Name): JACOB GERHARD ZITTERKOPF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 W 84TH AVE UNIT B8
DENVER CO
80260-4753
US

IV. Provider business mailing address

2221 E BIJOU ST STE 100
COLORADO SPRINGS CO
80909-8009
US

V. Phone/Fax

Practice location:
  • Phone: 720-214-4746
  • Fax: 720-214-4745
Mailing address:
  • Phone: 719-576-1850
  • Fax: 719-955-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN.00203288
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: