Provider Demographics
NPI:1154409571
Name:ZIRKIN, SCOTT LOUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LOUIS
Last Name:ZIRKIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 DANCER LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8875
Mailing Address - Country:US
Mailing Address - Phone:732-683-0077
Mailing Address - Fax:
Practice Address - Street 1:2130 HIGHWAY 35
Practice Address - Street 2:SUITE 121
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1010
Practice Address - Country:US
Practice Address - Phone:732-449-1166
Practice Address - Fax:732-449-3344
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI183721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics