Provider Demographics
NPI:1598839235
Name:ZAMBITO, ALBERT J (DDS)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:J
Last Name:ZAMBITO
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 1:851 PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4586
Mailing Address - Country:US
Mailing Address - Phone:262-248-4991
Mailing Address - Fax:262-248-0397
Practice Address - Street 1:851 PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4586
Practice Address - Country:US
Practice Address - Phone:262-248-4991
Practice Address - Fax:262-248-0397
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI58741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice