Individual
ZIVIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5200 S WESTNEDGE AVE, PORTAGE, MI 49002
(269) 382-6656
Mailing address
PMB 121-10001, SAIPAN, MP 96950
(670) 235-2378
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901021641
MI
Other
Enumeration date
06/11/2015
Last updated
03/26/2021
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