Provider Demographics
NPI:1194800532
Name:ZAK, DANIEL KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KENNETH
Last Name:ZAK
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 1:308 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:WI
Mailing Address - Zip Code:54165-1432
Mailing Address - Country:US
Mailing Address - Phone:920-833-6593
Mailing Address - Fax:920-833-6593
Practice Address - Street 1:308 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:WI
Practice Address - Zip Code:54165-1432
Practice Address - Country:US
Practice Address - Phone:920-833-6593
Practice Address - Fax:920-833-6593
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1633G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33548000Medicaid