Provider Demographics
NPI:1083880371
Name:JAHIMIAK, DAVID RALPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RALPH
Last Name:JAHIMIAK
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 1:2137 WARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7330
Mailing Address - Country:US
Mailing Address - Phone:608-788-8544
Mailing Address - Fax:608-788-8678
Practice Address - Street 1:2137 WARD AVENUE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7330
Practice Address - Country:US
Practice Address - Phone:608-788-8544
Practice Address - Fax:608-788-8678
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist