Healthcare Provider Details

I. General information

NPI: 1174691182
Provider Name (Legal Business Name): CHRISTOPHER LOUIS ZACHARIAS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14115 JAMES RD
ROGERS MN
55374-9468
US

IV. Provider business mailing address

14115 JAMES ROAD
ROGERS MN
55374
US

V. Phone/Fax

Practice location:
  • Phone: 763-428-2226
  • Fax:
Mailing address:
  • Phone: 763-428-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD 11070
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: