Healthcare Provider Details

I. General information

NPI: 1417152810
Provider Name (Legal Business Name): ATHANASIOS I. ZAVRAS DDS, MS, DRMSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST SUITE PH17W-306
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

64 PINE ST
DOVER MA
02030-2426
US

V. Phone/Fax

Practice location:
  • Phone: 617-818-0573
  • Fax:
Mailing address:
  • Phone: 617-818-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number50 - 055978
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN1855922
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number50 - 055978
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN1855922
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: