MEDICARE: GUIZHEN ZHANG 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
1	1223P0300X	Periodontics	S28	MN

General Provider Information

NPI Number	:	1770744146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUIZHEN ZHANG DDS

Provider Business Mailing Address
First Line	:	4801 HIGHWAY 61 N STE 300
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-2753
Country	:	US
Telephone Number	:	651-497-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 HIGHWAY 61 N STE 300
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-2753
Country	:	US
Telephone Number	:	651-429-2299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	07/20/2009

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