Provider Demographics
NPI:1528349800
Name:ZECKEL, ISAAC NATHAN (DDS)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:NATHAN
Last Name:ZECKEL
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 1:1001 NORTH STURDY RD.
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4126
Mailing Address - Country:US
Mailing Address - Phone:219-462-7173
Mailing Address - Fax:219-462-7504
Practice Address - Street 1:1001 NORTH STURDY RD.
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4126
Practice Address - Country:US
Practice Address - Phone:219-462-7173
Practice Address - Fax:219-462-7504
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011730A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist