Provider Demographics
NPI:1457401218
Name:ZAVADSKY, DANIEL S (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:ZAVADSKY
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 1:215 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
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50010951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33547300Medicaid