Provider Demographics
NPI:1992888127
Name:CHARLES F ZAMMERILLA DDS PC
Entity type:Organization
Organization Name:CHARLES F ZAMMERILLA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:ZAMMERILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:724-375-5088
Mailing Address - Street 1:2110 MCLEAN ST
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2964
Mailing Address - Country:US
Mailing Address - Phone:724-375-5088
Mailing Address - Fax:724-427-4309
Practice Address - Street 1:2110 MCLEAN ST
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2964
Practice Address - Country:US
Practice Address - Phone:724-375-5088
Practice Address - Fax:724-375-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027558L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA679870OtherUNITED CONCORDIA CO INS
TX173462232550OtherMETLIFE DENTAL