Healthcare Provider Details

I. General information

NPI: 1992725642
Provider Name (Legal Business Name): STEPHEN LEWIS ZONIES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 FIDDLERS GRN UNIT 1
WAITSFIELD VT
05673-6007
US

IV. Provider business mailing address

754 STAGECOACH RD
FAYSTON VT
05673-7092
US

V. Phone/Fax

Practice location:
  • Phone: 802-496-2524
  • Fax: 802-329-2085
Mailing address:
  • Phone: 802-496-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number592
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: