Provider Demographics
NPI:1487304317
Name:WULLBRANDT, ZACHARIAH CHARLES
Entity type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:CHARLES
Last Name:WULLBRANDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3747
Mailing Address - Country:US
Mailing Address - Phone:603-357-6385
Mailing Address - Fax:
Practice Address - Street 1:113 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3747
Practice Address - Country:US
Practice Address - Phone:603-357-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH049481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty