Healthcare Provider Details

I. General information

NPI: 1770571762
Provider Name (Legal Business Name): N. WAYNE ZAAYENGA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 SHIP RD
WEST CHESTER PA
19380-1308
US

IV. Provider business mailing address

1302 SHIP RD
WEST CHESTER PA
19380-1308
US

V. Phone/Fax

Practice location:
  • Phone: 610-431-9651
  • Fax: 610-431-9759
Mailing address:
  • Phone: 610-431-9651
  • Fax: 610-431-9759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS026024L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: