Healthcare Provider Details

I. General information

NPI: 1245284637
Provider Name (Legal Business Name): ERIN ZIZAK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

832 PATUXENT RUN CIR
ODENTON MD
21113-4035
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-4650
  • Fax:
Mailing address:
  • Phone: 410-695-1759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number13777
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: