Provider Demographics
NPI:1861781643
Name:ZUNIGA, EDGARDO (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:
Last Name:ZUNIGA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178
Mailing Address - Country:US
Mailing Address - Phone:248-617-3747
Mailing Address - Fax:248-617-3748
Practice Address - Street 1:112 E LAKE ST
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178
Practice Address - Country:US
Practice Address - Phone:248-617-3747
Practice Address - Fax:248-617-3748
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016006631223E0200X
MI29010217191223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics