Healthcare Provider Details

I. General information

NPI: 1659481901
Provider Name (Legal Business Name): IRVING I ZAMIKOFF DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 59TH STREET WEST
BRADENTON FL
34209
US

IV. Provider business mailing address

2103 59TH STREET WEST
BRADENTON FL
34209
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2766
  • Fax: 941-795-7531
Mailing address:
  • Phone: 941-792-2766
  • Fax: 941-795-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN6193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: