Healthcare Provider Details

I. General information

NPI: 1033274907
Provider Name (Legal Business Name): DEREK STEPHEN ZURN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 PARK ST BLDG C
STOUGHTON MA
02072-3650
US

IV. Provider business mailing address

574 PEAKHAM RD
SUDBURY MA
01776-2236
US

V. Phone/Fax

Practice location:
  • Phone: 781-341-0030
  • Fax:
Mailing address:
  • Phone: 978-443-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21069
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21571
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: