Provider Demographics
NPI:1285785386
Name:ZATCOFF, ADAM LYLE (DMD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:LYLE
Last Name:ZATCOFF
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 1:30 STONER AVE
Mailing Address - Street 2:APT 1F
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:973-600-4986
Mailing Address - Fax:516-466-6369
Practice Address - Street 1:30 STONER AVE
Practice Address - Street 2:APT 1F
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2117
Practice Address - Country:US
Practice Address - Phone:973-600-4986
Practice Address - Fax:516-466-6369
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0510101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics