| NPI | 1154437986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD KRISTOPHER ZAMBON Pediatric Dentist 262-255-7820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5490-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 3169) |
| 1223G0001X Dentist, General Practice (Licence: WI 3507) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 5203-015) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2025-09-11 |