Provider Demographics
NPI:1679785620
Name:ZATROCH, JESSICA K (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:K
Last Name:ZATROCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35040 CHARDON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9006
Mailing Address - Country:US
Mailing Address - Phone:440-951-9966
Mailing Address - Fax:440-951-3632
Practice Address - Street 1:35040 CHARDON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9006
Practice Address - Country:US
Practice Address - Phone:440-951-9966
Practice Address - Fax:440-951-3632
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0222041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice