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: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12359 SUNRISE VALLEY DR STE 300
RESTON VA
20191-3463
US

IV. Provider business mailing address

3175 12TH ST N APT 660
ARLINGTON VA
22201-7076
US

V. Phone/Fax

Practice location:
  • Phone: 703-435-7100
  • Fax:
Mailing address:
  • Phone: 216-832-8946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0438000555
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419888
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS043628
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: