1417294612 NPI number — DR. SHANE MICHAEL ZACHAREWICZ DDS

Table of content: MR. DAVID JOHN MACDOUGALL D.O., F.A.C.O.S., PA (NPI 1376662726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417294612 NPI number — DR. SHANE MICHAEL ZACHAREWICZ DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZACHAREWICZ
Provider First Name:
SHANE
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZACK
Provider Other First Name:
SHANE
Provider Other Middle Name:
MICHAEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1417294612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1037 S STATE ROAD 7
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-6138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-839-1802
Provider Business Mailing Address Fax Number:
561-839-1803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1037 S STATE ROAD 7
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-6138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-839-1802
Provider Business Practice Location Address Fax Number:
561-839-1803
Provider Enumeration Date:
01/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN18547 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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