Healthcare Provider Details

I. General information

NPI: 1528211844
Provider Name (Legal Business Name): ALLEN MARTIN ZUCH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 N GREELEY AVE 2ND FLOOR
CHAPPAQUA NY
10514-3409
US

IV. Provider business mailing address

75 N GREELEY AVE 2ND FLOOR
CHAPPAQUA NY
10514-3409
US

V. Phone/Fax

Practice location:
  • Phone: 914-238-0018
  • Fax: 914-238-1430
Mailing address:
  • Phone: 914-238-0018
  • Fax: 914-238-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number042021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: