Provider Demographics
NPI:1821830605
Name:DUKLETH, ZACHARY TAYLOR (DDS)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:TAYLOR
Last Name:DUKLETH
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 1:108 MICHIGAN AVE W
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-2274
Mailing Address - Country:US
Mailing Address - Phone:218-547-1851
Mailing Address - Fax:
Practice Address - Street 1:108 MICHIGAN AVE W
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-2274
Practice Address - Country:US
Practice Address - Phone:218-547-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND150791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice