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General NPI Number Information
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NPI Number | 1538627310
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Entity Type | Individual
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Provider Name | NICKOLAOS ZACKARY KALLIS DMD
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Gender | Male
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 1010 MAIN ST FL 2
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City | PATERSON
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State | NJ
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Zip | 07503-2212
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Country | US
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Telephone | 862-881-4153
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Fax |
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Provider Business Mailing Address
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Address Line | 63 UNION AVE
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City | UPPER SADDLE RIVER
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State | NJ
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Zip | 07458-2024
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Country | US
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Telephone | 941-720-2529
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 060277
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI02741100
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License Number State | NJ
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