Provider Demographics
NPI:1477287712
Name:HUYBRECHT, ZACHERY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZACHERY
Middle Name:
Last Name:HUYBRECHT
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 1:4646 AUTUMN BLAZE TRL
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-2476
Mailing Address - Country:US
Mailing Address - Phone:715-292-5250
Mailing Address - Fax:
Practice Address - Street 1:302 N SPRING ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2044
Practice Address - Country:US
Practice Address - Phone:920-887-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60000401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice