Provider Demographics
NPI:1144325317
Name:THOMAS J. ZANELLA, DDS PA
Entity type:Organization
Organization Name:THOMAS J. ZANELLA, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZANELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-446-7332
Mailing Address - Street 1:1201 S. HIGHLAND AVE.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4359
Mailing Address - Country:US
Mailing Address - Phone:727-446-7332
Mailing Address - Fax:727-443-4328
Practice Address - Street 1:1201 S. HIGHLAND AVE.
Practice Address - Street 2:SUITE 3
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4359
Practice Address - Country:US
Practice Address - Phone:727-446-7332
Practice Address - Fax:727-443-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12230122300000X
FLDN122301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070977800Medicaid