Provider Demographics
NPI:1104084490
Name:BINZAK, DANIEL E (DDS)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:E
Last Name:BINZAK
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 1:2600 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1956
Mailing Address - Country:US
Mailing Address - Phone:920-730-0400
Mailing Address - Fax:920-730-1114
Practice Address - Street 1:2600 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1956
Practice Address - Country:US
Practice Address - Phone:920-730-0400
Practice Address - Fax:920-730-1114
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3396-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist