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General NPI Number Information
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NPI Number | 1407022031
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Entity Type | Individual
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Provider Name | JASON WESLEY ZITOFSKY D.D.S
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Gender | Male
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Dates
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Enumeration Date | 05/04/2008
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 22 TRUCK HOUSE RD SUITE 3
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City | SEVERNA PARK
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State | MD
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Zip | 21146-2728
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Country | US
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Telephone | 410-647-4269
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Fax | 410-544-5910
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Provider Business Mailing Address
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Address Line | 22 TRUCK HOUSE RD SUITE 3
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City | SEVERNA PARK
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State | MD
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Zip | 21146-2728
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Country | US
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Telephone | 410-647-4269
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Fax | 410-544-5910
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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 | 14085
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License Number State | MD
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