Healthcare Provider Details

I. General information

NPI: 1952550188
Provider Name (Legal Business Name): MARY PAULA ZAYTOUN DDS MSO AND HENRY S ZAYTOUN JR DDS MSO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
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 Number1284
License Number StateNC

VIII. Authorized Official

Name: DR. HENRY STANLEY ZAYTOUN JR.
Title or Position: PRESIDENT
Credential: DDS, MSO
Phone: 919-782-6911