Healthcare Provider Details

I. General information

NPI: 1275972507
Provider Name (Legal Business Name): DEVIN M ZOLNOWSKI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 07/04/2020
Certification Date: 07/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 UNION AVE
HOLBROOK NY
11741-1831
US

IV. Provider business mailing address

264 UNION AVE
HOLBROOK NY
11741-1831
US

V. Phone/Fax

Practice location:
  • Phone: 631-588-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number057564
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: