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General NPI Number Information
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NPI Number | 1225131782
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Entity Type | Individual
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Provider Name | GARY LEE ZOUTENDAM DDS
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 491 E COLUMBIA AVE STE 3
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City | BATTLE CREEK
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State | MI
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Zip | 49015
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Country | US
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Telephone | 269-962-8505
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Fax | 269-962-9160
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Provider Business Mailing Address
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Address Line | 491 E COLUMBIA AVE STE 3
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City | BATTLE CREEK
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State | MI
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Zip | 49015
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Country | US
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Telephone | 269-962-8505
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Fax | 269-962-9160
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | GZ10510
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License Number State | MI
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