Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901012571 | MI |
NPI | 1003997487 |
---|---|
Provider Name | Dr. Eugene Julian Zwolak |
First Address | Rochester Hills, MI 48309-2328 |
Second Address | Center Line, MI 48015-1224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |