Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DEN2713 | ME |
NPI | 1063627107 |
---|---|
Provider Name | Edward R Zanca |
First Address | Bangor, ME 04402-1599 |
Second Address | Bangor, ME 04401-3016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 05/05/2021 |