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General NPI Number Information
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NPI Number | 1396103875
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Entity Type | Organization
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Legal Business Name | ZDENTIST LLC
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 1522 POINTER RIDGE PL SUITE K
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City | BOWIE
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State | MD
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Zip | 20716-1875
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Country | US
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Telephone | 508-904-5287
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 CHARMUTH RD
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City | LUTHERVILLE
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State | MD
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Zip | 21093-5757
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Country | US
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Telephone | 508-904-5287
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DMITRY NURMINSKY
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Credential | DDS PHD
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Telephone | 508-904-5287
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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 | 15795
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License Number State | MD
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