Provider Demographics
NPI:1194930297
Name:ZUKNICK, STEPHEN J (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:ZUKNICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 W ROBERTSON ST STE C
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5014
Mailing Address - Country:US
Mailing Address - Phone:813-685-0809
Mailing Address - Fax:813-685-3290
Practice Address - Street 1:413 W ROBERTSON ST STE C
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5014
Practice Address - Country:US
Practice Address - Phone:813-685-0809
Practice Address - Fax:813-685-3290
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice