Healthcare Provider Details

I. General information

NPI: 1972434934
Provider Name (Legal Business Name): LUKE MATTHEW ZORTMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36220 TOWER DR
WHITEHALL WI
54773-8524
US

IV. Provider business mailing address

S101W32890 WESTPOINTE DR
MUKWONAGO WI
53149-9559
US

V. Phone/Fax

Practice location:
  • Phone: 715-597-7716
  • Fax:
Mailing address:
  • Phone: 262-470-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6002185
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: