Healthcare Provider Details

I. General information

NPI: 1477615045
Provider Name (Legal Business Name): DOMENICO ZITO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W CHESTER PIKE SUITE 850A
NEWTOWN SQUARE PA
19073-4638
US

IV. Provider business mailing address

126 DEERFIELD RD
BROOMALL PA
19008-2035
US

V. Phone/Fax

Practice location:
  • Phone: 610-356-3343
  • Fax: 610-356-3344
Mailing address:
  • Phone: 610-356-5986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS 025385-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: