1992888127 NPI number — CHARLES F ZAMMERILLA DDS PC

Table of content: (NPI 1992888127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992888127 NPI number — CHARLES F ZAMMERILLA DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES F ZAMMERILLA DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992888127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2110 MCLEAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALIQUIPPA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15001-2964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-375-5088
Provider Business Mailing Address Fax Number:
724-427-4309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2110 MCLEAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALIQUIPPA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15001-2964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-375-5088
Provider Business Practice Location Address Fax Number:
724-375-8510
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZAMMERILLA
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
FREDERICK
Authorized Official Title or Position:
GENERAL DENTIST
Authorized Official Telephone Number:
724-375-5088

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS027558L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 679870 . This is a "UNITED CONCORDIA CO INS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 173462232550 . This is a "METLIFE DENTAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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