Healthcare Provider Details

I. General information

NPI: 1972656924
Provider Name (Legal Business Name): GEORGE RAYMOND ZUNDO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W FAIRCHILD ST
DANVILLE IL
61832-3710
US

IV. Provider business mailing address

907 W FAIRCHILD ST
DANVILLE IL
61832-3710
US

V. Phone/Fax

Practice location:
  • Phone: 217-431-1440
  • Fax: 217-431-1977
Mailing address:
  • Phone: 217-431-1440
  • Fax: 217-431-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: