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General NPI Number Information
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NPI Number | 1720379993
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Entity Type | Organization
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Legal Business Name | NEWBURYPORTPERIOLTD,PC
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 21 HIGHLAND AVE STE 6
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City | NEWBURYPORT
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State | MA
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Zip | 01950-3873
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Country | US
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Telephone | 978-358-7522
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Fax | 978-255-2156
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Provider Business Mailing Address
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Address Line | 21 HIGHLAND AVE STE 6
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City | NEWBURYPORT
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State | MA
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Zip | 01950-3873
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Country | US
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Telephone | 978-358-7522
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Fax | 978-255-2156
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. HOWARD M ZOLOT
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Credential | DMD
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Telephone | 978-358-7522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | MA15612
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License Number State | MA
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