Healthcare Provider Details

I. General information

NPI: 1417045717
Provider Name (Legal Business Name): ROBERT MYRON ZUPNIK DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8218 WISCONSIN AVENUE SUITE 203
BETHESDA MD
20814-3107
US

IV. Provider business mailing address

8218 WISCONSIN AVENUE SUITE 203
BETHESDA MD
20814-3107
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-0331
  • Fax: 301-656-1325
Mailing address:
  • Phone: 301-656-0331
  • Fax: 301-656-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3361
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: