Healthcare Provider Details

I. General information

NPI: 1457707739
Provider Name (Legal Business Name): EVAN L. ZINGARO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 BATAVIA CITY CTR
BATAVIA NY
14020-2107
US

IV. Provider business mailing address

37 BATAVIA CITY CENTRE
BATAVIA NY
14020-2107
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-1113
  • Fax:
Mailing address:
  • Phone: 585-343-1113
  • Fax: 585-343-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number21990
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number059295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: