Healthcare Provider Details

I. General information

NPI: 1447471032
Provider Name (Legal Business Name): QIANG ZHU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE UNIVERSITY DENTISTS
FARMINGTON CT
06030-2820
US

IV. Provider business mailing address

263 FARMINGTON AVENUE UNIVERSITY DENTISTS
FARMINGTON CT
06030-2820
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3170
  • Fax: 860-679-8162
Mailing address:
  • Phone: 860-679-3170
  • Fax: 860-679-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberP08327
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: