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General NPI Number Information
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NPI Number | 1770837288
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Entity Type | Organization
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Legal Business Name | ZEN DENTAL
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 650 HORTON ROAD
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City | N. MUSKEGON
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State | MI
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Zip | 49445
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Country | US
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Telephone | 231-744-2387
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Fax | 231-744-2387
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Provider Business Mailing Address
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Address Line | 650 HORTON ROAD
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City | N. MUSKEGON
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State | MI
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Zip | 49445
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Country | US
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Telephone | 231-744-2387
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Fax |
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Authorized Official
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Title or Position | DENTAL HYGIENIST
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Name | MRS. ZENAIDA VASQUEZ-JOHNSON
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Credential | R.D.H.
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Telephone | 231-744-2387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902005276
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License Number State | MI
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