Healthcare Provider Details

I. General information

NPI: 1679865356
Provider Name (Legal Business Name): STEVEN J ZOMBEK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 SHERIDAN ST
HOLLYWOOD FL
33021-3511
US

IV. Provider business mailing address

4480 SHERIDAN ST
HOLLYWOOD FL
33021-3511
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-2695
  • Fax:
Mailing address:
  • Phone: 954-961-2695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN17844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: