Healthcare Provider Details

I. General information

NPI: 1194902411
Provider Name (Legal Business Name): WOLODYMYR ZIN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9892 BUSTLETON AVE. SUITE 302
PHILADELPHIA PA
19115
US

IV. Provider business mailing address

9892 BUSTLETON AVE. SUITE 302
PHILADELPHIA PA
19115
US

V. Phone/Fax

Practice location:
  • Phone: 215-671-0188
  • Fax:
Mailing address:
  • Phone: 215-671-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS037285
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02367100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: