Provider Demographics
NPI:1154437986
Name:DENTAL PROFESSIONALS
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:KRISTOPHER
Authorized Official - Last Name:ZAMBON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-255-7820
Mailing Address - Street 1:N112W16760 MEQUON RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-5814
Mailing Address - Country:US
Mailing Address - Phone:262-255-7820
Mailing Address - Fax:262-255-9969
Practice Address - Street 1:N112W16760 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-5814
Practice Address - Country:US
Practice Address - Phone:262-255-7820
Practice Address - Fax:262-255-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31691223G0001X
WI35071223G0001X
WI5490-0151223G0001X
WI5203-0151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty