Healthcare Provider Details

I. General information

NPI: 1629320569
Provider Name (Legal Business Name): KATHERINE M ZUCCARELLI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 EAGLE RIDGE DR
SCHERERVILLE IN
46375-1360
US

IV. Provider business mailing address

1314 EAGLE RIDGE DR
SCHERERVILLE IN
46375-1360
US

V. Phone/Fax

Practice location:
  • Phone: 219-865-4095
  • Fax:
Mailing address:
  • Phone: 219-865-4095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12010809A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: