Healthcare Provider Details

I. General information

NPI: 1891750683
Provider Name (Legal Business Name): NICHOLAS M ZANAKOS JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 TAMIAMI TRL STE 604
PORT CHARLOTTE FL
33952-9283
US

IV. Provider business mailing address

4010 W BOY SCOUT BLVD STE 1100
TAMPA FL
33607-5796
US

V. Phone/Fax

Practice location:
  • Phone: 941-255-8500
  • Fax: 941-255-8503
Mailing address:
  • Phone: 813-288-6264
  • Fax: 813-289-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN14010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: