Provider Demographics
NPI:1871643635
Name:DANIEL S ZAVADSKY DDS SC
Entity Type:Organization
Organization Name:DANIEL S ZAVADSKY DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZAVADSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-524-4212
Mailing Address - Street 1:215 N WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1606
Mailing Address - Country:US
Mailing Address - Phone:608-524-4212
Mailing Address - Fax:608-524-4212
Practice Address - Street 1:215 N WEBB AVE
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1606
Practice Address - Country:US
Practice Address - Phone:608-524-4212
Practice Address - Fax:608-524-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001095261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33547300Medicaid