Provider Demographics
NPI:1063624419
Name:ROBERT G. ZATROCH, D.D.S., INC
Entity type:Organization
Organization Name:ROBERT G. ZATROCH, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZATROCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-951-9966
Mailing Address - Street 1:JESSICA K. ZATROCH, DDS, INC.
Mailing Address - Street 2:35040 CHARDON ROAD, SUITE 100
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094
Mailing Address - Country:US
Mailing Address - Phone:440-951-9966
Mailing Address - Fax:440-951-3632
Practice Address - Street 1:JESSICA K. ZATROCH, DDS, INC.
Practice Address - Street 2:35040 CHARDON ROAD, SUITE 100
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:440-951-9966
Practice Address - Fax:440-951-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0222041223G0001X
OH30.0146131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty