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General NPI Number Information
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NPI Number | 1285318055
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Entity Type | Individual
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Provider Name | KEYU ZHAO DMD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 4824 E TRINDLE RD
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City | MECHANICSBURG
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State | PA
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Zip | 17050-3617
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Country | US
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Telephone | 717-761-8056
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FOREST CREEK LN
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City | WILMINGTON
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State | DE
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Zip | 19809-1373
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS044146
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License Number State | PA
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