Individual provider Active NPI

Allen Zebrack, D.D.S.

  • Dentist
  • North Hollywood, CA
National Provider Identifier
1801002365
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
33180 Issued in CA
Practice address
12840 Riverside Dr Ste 406
North Hollywood, CA 91607-3351
Phone
(818) 763-9701
Fax
(818) 763-5542
NPI assigned
May 14, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 33180 CA Primary

Addresses

Primary practice location

12840 Riverside Dr Ste 406
North Hollywood, CA 91607-3351

Mailing address

12840 Riverside Dr Ste 406
North Hollywood, CA 91607-3351
Phone (818) 763-9701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160620001568 CA Order and Referring Only - DentistPractitioner - Dentist 5991096133

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33180CAMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801002365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12840 RIVERSIDE DR STE 406",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916073351",
            "telephone_number": "818-763-9701",
            "fax_number": "818-763-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12840 RIVERSIDE DR STE 406",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916073351",
            "telephone_number": "818-763-9701",
            "fax_number": "818-763-5542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEBRACK",
        "first_name": "ALLEN",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "33180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Hollywood, CA

Sources for this page

Verify at the official NPI Registry.