Healthcare Provider Details

I. General information

NPI: 1447066121
Provider Name (Legal Business Name): UTE R ZOLKOWSKI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 KINGS CT
ALCOA TN
37701-1939
US

IV. Provider business mailing address

6032 AUTUMN OAKS LN
KNOXVILLE TN
37921-3938
US

V. Phone/Fax

Practice location:
  • Phone: 865-983-6361
  • Fax:
Mailing address:
  • Phone: 865-803-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH5250
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: