Healthcare Provider Details

I. General information

NPI: 1659573574
Provider Name (Legal Business Name): ERIC J ZIDEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 WINCHESTER PIKE
COLUMBUS OH
43232-5605
US

IV. Provider business mailing address

2424 BEXLEY PARK RD
BEXLEY OH
43209-2120
US

V. Phone/Fax

Practice location:
  • Phone: 614-837-2080
  • Fax:
Mailing address:
  • Phone: 614-246-0802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21579
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: