Provider Demographics
NPI:1700999190
Name:ZIEGNER, MARTIN KURT (DDS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:KURT
Last Name:ZIEGNER
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 1:100 W ROOSEVELT RD
Mailing Address - Street 2:202
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5260
Mailing Address - Country:US
Mailing Address - Phone:630-682-3211
Mailing Address - Fax:
Practice Address - Street 1:100 W ROOSEVELT RD
Practice Address - Street 2:202
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5260
Practice Address - Country:US
Practice Address - Phone:630-682-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-140011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice