Healthcare Provider Details

I. General information

NPI: 1396994513
Provider Name (Legal Business Name): HENRY STANLEY ZAYTOUN JR. DDS, MSO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 SIX FORKS RD SUITE 200
RALEIGH NC
27609-4493
US

IV. Provider business mailing address

5041 SIX FORKS RD SUITE 200
RALEIGH NC
27609-4493
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-6911
  • Fax: 919-782-6913
Mailing address:
  • Phone: 919-782-6911
  • Fax: 919-782-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5254
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: