Healthcare Provider Details

I. General information

NPI: 1619562832
Provider Name (Legal Business Name): ADAM ZUCKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WALNUT ST
PHILADELPHIA PA
19107-5211
US

IV. Provider business mailing address

2101 MARKET ST UNIT 2905
PHILADELPHIA PA
19103-1366
US

V. Phone/Fax

Practice location:
  • Phone: 215-995-6215
  • Fax:
Mailing address:
  • Phone: 216-832-8946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS043628
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: