Healthcare Provider Details

I. General information

NPI: 1710145073
Provider Name (Legal Business Name): STEVEN R ZUKERBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PARK AVE STE L104
BALTIMORE MD
21201-5651
US

IV. Provider business mailing address

1111 PARK AVE STE L104
BALTIMORE MD
21201-5651
US

V. Phone/Fax

Practice location:
  • Phone: 410-669-6964
  • Fax: 410-486-0891
Mailing address:
  • Phone: 410-669-6964
  • Fax: 410-486-9681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6736
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: