Healthcare Provider Details

I. General information

NPI: 1033259825
Provider Name (Legal Business Name): GRETCHEN RAYMOND ZODY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 OFFICE PKWY
WESTERVILLE OH
43082-7814
US

IV. Provider business mailing address

627 OFFICE PKWY
WESTERVILLE OH
43082-7814
US

V. Phone/Fax

Practice location:
  • Phone: 614-882-1135
  • Fax: 614-882-4911
Mailing address:
  • Phone: 614-882-1135
  • Fax: 614-882-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberOH19132
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: