Healthcare Provider Details

I. General information

NPI: 1154304319
Provider Name (Legal Business Name): ANDREW P. ZATERKA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAIN ST SUITE 2
SOUTHBOROUGH MA
01772-1661
US

IV. Provider business mailing address

14 GRAYSTONE WAY
SOUTHBOROUGH MA
01772-1300
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-6100
  • Fax: 508-485-8734
Mailing address:
  • Phone: 508-481-6100
  • Fax: 508-485-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18615
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: