Healthcare Provider Details

I. General information

NPI: 1609024561
Provider Name (Legal Business Name): ANNA JEANNETTE ZAK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S CODY RD SUITE A
LE CLAIRE IA
52753-9236
US

IV. Provider business mailing address

PO BOX 814
LE CLAIRE IA
52753-0814
US

V. Phone/Fax

Practice location:
  • Phone: 563-289-3249
  • Fax: 563-289-8133
Mailing address:
  • Phone: 563-289-3249
  • Fax: 563-289-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number08678
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: