Healthcare Provider Details

I. General information

NPI: 1568528404
Provider Name (Legal Business Name): THOMAS J ZBARACKI JR. DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 MATTERHORN DRIVE STE 1
DULUTH MN
55811
US

IV. Provider business mailing address

5005 MATTERHORN DRIVE STE 1
DULUTH MN
55811
US

V. Phone/Fax

Practice location:
  • Phone: 218-625-8630
  • Fax: 218-625-8632
Mailing address:
  • Phone: 218-625-8630
  • Fax: 218-625-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD8329
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: