Healthcare Provider Details

I. General information

NPI: 1114077492
Provider Name (Legal Business Name): PAUL-HENRY H ZOTTOLA D.M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 SILAS DEANE HWY
ROCKY HILL CT
06067-2329
US

IV. Provider business mailing address

2275 SILAS DEANE HWY
ROCKY HILL CT
06067-2329
US

V. Phone/Fax

Practice location:
  • Phone: 860-436-9571
  • Fax: 960-436-9573
Mailing address:
  • Phone: 860-436-9571
  • Fax: 960-436-9573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number008966
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: