Healthcare Provider Details

I. General information

NPI: 1003890443
Provider Name (Legal Business Name): ROBERT J ZATZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 ELLINGTON RD
SOUTH WINDSOR CT
06074-2768
US

IV. Provider business mailing address

1740 ELLINGTON RD
SOUTH WINDSOR CT
06074-2768
US

V. Phone/Fax

Practice location:
  • Phone: 860-644-2486
  • Fax: 860-644-2487
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7059
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: