Healthcare Provider Details

I. General information

NPI: 1649372293
Provider Name (Legal Business Name): MARK ROY ZEMANOVICH DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SALEM CHURCH RD
STEPHENS CITY VA
22655-5314
US

IV. Provider business mailing address

203 SALEM CHURCH RD
STEPHENS CITY VA
22655-5314
US

V. Phone/Fax

Practice location:
  • Phone: 540-868-2740
  • Fax:
Mailing address:
  • Phone: 540-868-2740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0401411115
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: