Provider Demographics
NPI:1609024561
Name:ZAK, ANNA JEANNETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:JEANNETTE
Last Name:ZAK
Suffix:
Gender:F
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:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-0814
Mailing Address - Country:US
Mailing Address - Phone:563-289-3249
Mailing Address - Fax:563-289-8133
Practice Address - Street 1:126 S CODY RD
Practice Address - Street 2:SUITE A
Practice Address - City:LE CLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-9236
Practice Address - Country:US
Practice Address - Phone:563-289-3249
Practice Address - Fax:563-289-8133
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice