Healthcare Provider Details

I. General information

NPI: 1841773793
Provider Name (Legal Business Name): DONNA M ZAGAME RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 WASHINGTON RD
KENOSHA WI
53144-4819
US

IV. Provider business mailing address

20311 81ST ST
BRISTOL WI
53104-9711
US

V. Phone/Fax

Practice location:
  • Phone: 262-656-0044
  • Fax:
Mailing address:
  • Phone: 262-818-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6058-16
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: