Provider Demographics
NPI:1619139177
Name:ZWICK, ELLEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:M
Last Name:ZWICK
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 1:1021 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2359
Mailing Address - Country:US
Mailing Address - Phone:937-292-7828
Mailing Address - Fax:937-292-7916
Practice Address - Street 1:1021 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2359
Practice Address - Country:US
Practice Address - Phone:937-292-7828
Practice Address - Fax:937-292-7916
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0227761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice