Healthcare Provider Details

I. General information

NPI: 1972720019
Provider Name (Legal Business Name): DAVID LELAND ZATOPEK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E COLORADO ST
LA GRANGE TX
78945-2243
US

IV. Provider business mailing address

259 E COLORADO ST
LA GRANGE TX
78945-2243
US

V. Phone/Fax

Practice location:
  • Phone: 979-968-8889
  • Fax:
Mailing address:
  • Phone: 979-968-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD12397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: