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General NPI Number Information
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NPI Number | 1700381308
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Entity Type | Individual
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Provider Name | ZACHARY ALLEN MURSIC
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Gender | Male
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 27382 CALLE ARROYO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2746
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Country | US
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Telephone | 949-701-5014
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Fax |
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Provider Business Mailing Address
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Address Line | 2548 S YOUNG CT
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-4197
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Country | US
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Telephone | 909-522-6462
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 102161
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 102161
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License Number State | CA
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