Healthcare Provider Details

I. General information

NPI: 1669548871
Provider Name (Legal Business Name): MARK SAMUEL ZEMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MOUNTAIN VIEW DR SUITE A
CUMMING GA
30040-2400
US

IV. Provider business mailing address

103 MOUNTAIN VIEW DR
CUMMING GA
30040-2400
US

V. Phone/Fax

Practice location:
  • Phone: 770-887-0447
  • Fax: 770-887-9521
Mailing address:
  • Phone: 770-887-0447
  • Fax: 770-887-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9671
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: