Provider Demographics
NPI:1477536613
Name:ZANDER, JEFFREY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:ZANDER
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 1:152 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2200
Mailing Address - Country:US
Mailing Address - Phone:715-526-3314
Mailing Address - Fax:715-524-9893
Practice Address - Street 1:152 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2200
Practice Address - Country:US
Practice Address - Phone:715-526-3314
Practice Address - Fax:715-524-9893
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2262015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33386000Medicaid