Provider Demographics
NPI:1588919732
Name:ZASE, MARTIN H (DMD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:H
Last Name:ZASE
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 1:79A NORWICH AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-0193
Mailing Address - Country:US
Mailing Address - Phone:860-537-2351
Mailing Address - Fax:860-537-2354
Practice Address - Street 1:79A NORWICH AVENUE
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06413-0193
Practice Address - Country:US
Practice Address - Phone:860-537-2351
Practice Address - Fax:860-537-2354
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist