Provider Demographics
NPI:1033851464
Name:SCHUFELDT, ZACHARY DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DEAN
Last Name:SCHUFELDT
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 1:13925 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-6800
Mailing Address - Country:US
Mailing Address - Phone:402-957-6752
Mailing Address - Fax:
Practice Address - Street 1:1860 MADISON AVE STE 4
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5200
Practice Address - Country:US
Practice Address - Phone:712-256-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE78291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice