Healthcare Provider Details

I. General information

NPI: 1124122528
Provider Name (Legal Business Name): MARC D ZASLOW D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FILA WAY SUITE 201B
SPARKS MD
21152
US

IV. Provider business mailing address

10 FILA WAY SUITE 201B
SPARKS MD
21152
US

V. Phone/Fax

Practice location:
  • Phone: 410-472-9050
  • Fax: 410-472-9052
Mailing address:
  • Phone: 410-472-9050
  • Fax: 410-472-9052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12550
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: