Provider Demographics
NPI:1215333844
Name:ZANOCCO, CHRISTINE (RDH)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ZANOCCO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1121
Mailing Address - Country:US
Mailing Address - Phone:715-563-4539
Mailing Address - Fax:
Practice Address - Street 1:435 W ELM ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1121
Practice Address - Country:US
Practice Address - Phone:715-563-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6405-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist