Provider Demographics
NPI:1013571132
Name:ZIEBA DENTISTRY GURNEE, LTD.
Entity Type:Organization
Organization Name:ZIEBA DENTISTRY GURNEE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-456-8835
Mailing Address - Street 1:1259 N WOOD ST APT 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8800
Mailing Address - Country:US
Mailing Address - Phone:847-727-4077
Mailing Address - Fax:
Practice Address - Street 1:5101 WASHINGTON ST # 2V
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5916
Practice Address - Country:US
Practice Address - Phone:847-244-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental