Provider Demographics
NPI:1114044526
Name:ZMICK, MICHELLE N (DD,S,)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:N
Last Name:ZMICK
Suffix:
Gender:F
Credentials:DD,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5246 RFD
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9794
Mailing Address - Country:US
Mailing Address - Phone:847-821-1696
Mailing Address - Fax:847-821-1875
Practice Address - Street 1:5246 RFD
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-9794
Practice Address - Country:US
Practice Address - Phone:847-821-1696
Practice Address - Fax:847-821-1875
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0016706122300000X
IL021-10931223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0300XDental ProvidersDentistPeriodontics