Healthcare Provider Details

I. General information

NPI: 1811462732
Provider Name (Legal Business Name): KUSHAL G ZINZUVADIA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 SAINT BOTOLPH ST APT 10
BOSTON MA
02115-5118
US

IV. Provider business mailing address

162 SAINT BOTOLPH ST APT 10
BOSTON MA
02115-5118
US

V. Phone/Fax

Practice location:
  • Phone: 857-272-5494
  • Fax:
Mailing address:
  • Phone: 857-272-5494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858162
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: