MEDICARE: ZACHARY DUBIN DMD

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	1223G0001X	General Practice Dentistry	DN015976	GA

General Provider Information

NPI Number	:	1821628694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY DUBIN DMD

Provider Business Mailing Address
First Line	:	1704 LOGANS KNL NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-4100
Country	:	US
Telephone Number	:	404-791-5418
Fax Number	:

Provider Business Practice Location Address
First Line	:	2970 CLAIRMONT RD NE
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-1638
Country	:	US
Telephone Number	:	404-636-2763
Fax Number	:

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

Provider Enumeration Date	:	01/21/2020
Last Update Date	:	01/21/2020

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