Healthcare Provider Details

I. General information

NPI: 1528585569
Provider Name (Legal Business Name): XING ZHU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

779 SPRINGFIELD AVE
SUMMIT NJ
07901-2332
US

IV. Provider business mailing address

28 PAULDING TER
DANBURY CT
06810-5135
US

V. Phone/Fax

Practice location:
  • Phone: 908-739-3128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI02804900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number06890
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: