MEDICARE: DR. JEFFREY GEORGE ZELLER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	60198	KS
2	1223G0001X	General Practice Dentistry	7022-15	WI
3	1223G0001X	General Practice Dentistry	019.029319	IL
4	1223G0001X	General Practice Dentistry	59289	CA

General Provider Information

NPI Number	:	1730172248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY GEORGE ZELLER D.D.S.

Provider Business Mailing Address
First Line	:	1320 S. GREEN BAY RD.
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406
Country	:	US
Telephone Number	:	952-594-0969
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 S. GREEN BAY RD.
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406
Country	:	US
Telephone Number	:	262-637-9371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	04/11/2013

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