Healthcare Provider Details

I. General information

NPI: 1770837288
Provider Name (Legal Business Name): ZEN DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HORTON ROAD
N. MUSKEGON MI
49445
US

IV. Provider business mailing address

650 HORTON ROAD
N. MUSKEGON MI
49445
US

V. Phone/Fax

Practice location:
  • Phone: 231-744-2387
  • Fax: 231-744-2387
Mailing address:
  • Phone: 231-744-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902005276
License Number StateMI

VIII. Authorized Official

Name: MRS. ZENAIDA VASQUEZ-JOHNSON
Title or Position: DENTAL HYGIENIST
Credential: R.D.H.
Phone: 231-744-2387