Provider Demographics
NPI:1366432189
Name:ZAJKOWSKI, MARK D (DDS,MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:ZAJKOWSKI
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LONG CREEK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2425
Mailing Address - Country:US
Mailing Address - Phone:207-772-4063
Mailing Address - Fax:207-772-8641
Practice Address - Street 1:20 LONG CREEK DR
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2425
Practice Address - Country:US
Practice Address - Phone:207-772-4063
Practice Address - Fax:207-772-8641
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME35631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME316710099Medicaid
MEMM785301Medicare PIN
U75717Medicare UPIN
ME316710099Medicaid