Provider Demographics
NPI:1043052962
Name:WATERBURY, ZACHARY (DDS)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:WATERBURY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 200TH ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:IA
Mailing Address - Zip Code:50212-7488
Mailing Address - Country:US
Mailing Address - Phone:515-231-9140
Mailing Address - Fax:
Practice Address - Street 1:301 AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-2803
Practice Address - Country:US
Practice Address - Phone:515-386-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist