Provider Demographics
NPI:1023492147
Name:ZOLNIK, EMILY RACHEL (DDS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RACHEL
Last Name:ZOLNIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:DAUENHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4626 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4626 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6897
Practice Address - Country:US
Practice Address - Phone:260-432-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012358A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist