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General NPI Number Information
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NPI Number | 1235575499
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Entity Type | Organization
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Legal Business Name | TED D ZAHARAKO ESTATE
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 3154 N NATIONAL RD
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City | COLUMBUS
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State | IN
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Zip | 47201-3170
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Country | US
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Telephone | 812-372-0102
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Fax | 812-372-3875
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Provider Business Mailing Address
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Address Line | 431 WASHINGTON ST
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City | COLUMBUS
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State | IN
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Zip | 47201-6757
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Country | US
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Telephone | 812-376-6676
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Fax | 812-379-2498
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Authorized Official
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Title or Position | PERSONAL RESPENTATIVE
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Name | MRS. ALICE JEAN PHILLIPS
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Credential |
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Telephone | 812-342-9986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12007403
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License Number State | IN
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