Provider Demographics
NPI:1245600048
Name:ZAKHARIAN, ELENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:ZAKHARIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 US HIGHWAY 30 # B101
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8974
Mailing Address - Country:US
Mailing Address - Phone:630-801-1999
Mailing Address - Fax:
Practice Address - Street 1:2484 US HIGHWAY 30 # B101
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8974
Practice Address - Country:US
Practice Address - Phone:630-801-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist