Healthcare Provider Details

I. General information

NPI: 1134904089
Provider Name (Legal Business Name): HALA ZOMA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 MARKET PL
ONALASKA WI
54650-6705
US

IV. Provider business mailing address

3132 MARKET PL
ONALASKA WI
54650-6705
US

V. Phone/Fax

Practice location:
  • Phone: 608-783-5800
  • Fax:
Mailing address:
  • Phone: 608-783-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001330-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: