Provider Demographics
NPI:1164756979
Name:BADER, ZISHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZISHAN
Middle Name:
Last Name:BADER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 E ARMY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1647
Mailing Address - Country:US
Mailing Address - Phone:224-698-1472
Mailing Address - Fax:224-653-8478
Practice Address - Street 1:148 E ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1647
Practice Address - Country:US
Practice Address - Phone:224-698-1472
Practice Address - Fax:224-653-8478
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028083204E00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist