Healthcare Provider Details

I. General information

NPI: 1528133634
Provider Name (Legal Business Name): JEFFREY L ZYGAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25995 BARBER CUT OFF RD NE SUITE 2B
KINGSTON WA
98346-8456
US

IV. Provider business mailing address

25995 BARBER CUT OFF RD NE SUITE 2B
KINGSTON WA
98346-8456
US

V. Phone/Fax

Practice location:
  • Phone: 360-297-2298
  • Fax: 360-297-8445
Mailing address:
  • Phone: 360-297-2298
  • Fax: 360-297-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4422
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: