Healthcare Provider Details

I. General information

NPI: 1841292992
Provider Name (Legal Business Name): WILLIAM E ZWACK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 THOMAS JOHNSON DRIVE SUITE A
FREDENCH MD
21702
US

IV. Provider business mailing address

68 THOMAS JOHNSON DRIVE SUITE A
FREDENCH MD
21702
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-2300
  • Fax: 301-694-7372
Mailing address:
  • Phone: 301-694-2300
  • Fax: 301-694-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13178
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: