Healthcare Provider Details

I. General information

NPI: 1053699967
Provider Name (Legal Business Name): BRETT MICHAEL ZUCKMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DEARFIELD DR STE G-1
GREENWICH CT
06831-5351
US

IV. Provider business mailing address

4 DEARFIELD DR STE G-1
GREENWICH CT
06831-5351
US

V. Phone/Fax

Practice location:
  • Phone: 203-661-5858
  • Fax: 203-661-1159
Mailing address:
  • Phone: 203-661-5858
  • Fax: 203-661-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number055511-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: