Healthcare Provider Details

I. General information

NPI: 1154409571
Provider Name (Legal Business Name): SCOTT LOUIS ZIRKIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 HIGHWAY 35 SUITE 121
SEA GIRT NJ
08750-1010
US

IV. Provider business mailing address

807 DANCER LN
MANALAPAN NJ
07726-8875
US

V. Phone/Fax

Practice location:
  • Phone: 732-449-1166
  • Fax: 732-449-3344
Mailing address:
  • Phone: 732-683-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDI18372
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: