=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396586624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACHERY L. HONEYCUTT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2024
-----------------------------------------------------
Last Update Date | 07/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1717 CHESTER BLVD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47374-1612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-965-5959
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2329 OAK PARK DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47374-1674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-969-2152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12014805A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------