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NPI Code Detail

MEDICARE: DR. MARK JAMES ZIEMBA DDS

MEDICARE: DR. MARK JAMES ZIEMBA DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry12012502AIN

General Provider Information

NPI Number : 1093163503
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK JAMES ZIEMBA DDS
Provider Business Mailing Address
First Line : 5470 LAFAYETTE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-1620
Country : US
Telephone Number : 317-293-4611
Fax Number :
Provider Business Practice Location Address
First Line : 5470 LAFAYETTE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-1620
Country : US
Telephone Number : 317-293-4611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2016
Last Update Date : 03/12/2018

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Directions to “ DR. MARK JAMES ZIEMBA DDS” Practice Location

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