Healthcare Provider Details

I. General information

NPI: 1477848661
Provider Name (Legal Business Name): JEREMY ZUNIGA D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 PLAIN ST
MARSHFIELD MA
02050-2731
US

IV. Provider business mailing address

35 LEICESTER RD
BELMONT MA
02478-3324
US

V. Phone/Fax

Practice location:
  • Phone: 617-308-1306
  • Fax:
Mailing address:
  • Phone: 617-308-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1856124
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: