Healthcare Provider Details

I. General information

NPI: 1639230212
Provider Name (Legal Business Name): CHARLES STEPHEN ZITEK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEVE ZITEK DDS

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

1273 E RAINES RD
MEMPHIS TN
38116-5816
US

IV. Provider business mailing address

1273 E RAINES RD
MEMPHIS TN
38116-5816
US

V. Phone/Fax

Practice location:
  • Phone: 901-398-6435
  • Fax: 901-398-1987
Mailing address:
  • Phone: 901-398-6435
  • Fax: 901-398-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS0000002669
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: