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General NPI Number Information
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NPI Number | 1891750683
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Entity Type | Individual
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Provider Name | NICHOLAS M ZANAKOS JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 4161 TAMIAMI TRL STE 604
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-9283
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Country | US
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Telephone | 941-255-8500
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Fax | 941-255-8503
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Provider Business Mailing Address
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Address Line | 4010 W BOY SCOUT BLVD STE 1100
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City | TAMPA
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State | FL
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Zip | 33607-5796
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Country | US
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Telephone | 813-288-6264
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Fax | 813-289-7549
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN14010
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License Number State | FL
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