=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760889398
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JZ DENTAL, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2014
-----------------------------------------------------
Last Update Date | 11/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8616 QUEENS BLVD SUITE 203
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11373-4433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-457-8787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8616 QUEENS BLVD SUITE 203
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11373-4433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-457-8787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JEFFREY ZIAR
-----------------------------------------------------
Credential | DMD, MS
-----------------------------------------------------
Telephone | 646-643-4320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 049025-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------