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General NPI Number Information
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NPI Number | 1730172248
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Entity Type | Individual
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Provider Name | JEFFREY GEORGE ZELLER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 1320 S. GREEN BAY RD.
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City | RACINE
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State | WI
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Zip | 53406
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Country | US
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Telephone | 262-637-9371
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 S. GREEN BAY RD.
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City | RACINE
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State | WI
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Zip | 53406
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Country | US
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Telephone | 952-594-0969
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60198
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7022-15
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.029319
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 59289
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License Number State | CA
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