Ian Zlotolow, DMD
Individual provider Active NPI Dentist · Berkeley, CA
NPI 1750414835 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1750414835
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 53508 (CA)
- Practice address
- 1206 The Alameda
Berkeley, CA 94709-1907 - Phone
- (510) 525-7521
- Fax
- (510) 525-5262
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53508 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Weill Medical College of Cornell | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 53508 | CA | Yes |
Addresses
Primary practice location
1206 The Alameda
Berkeley, CA 94709-1907
Mailing address
1206 The Alameda
Berkeley, CA 94709-1907
Phone (510) 525-7521
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 53508 | Other | CA | LIC # |
Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.