Provider Demographics
NPI:1275919094
Name:DR. ZASSO & ASSOCIATES (SKOKIE), LTD.
Entity Type:Organization
Organization Name:DR. ZASSO & ASSOCIATES (SKOKIE), LTD.
Other - Org Name:DENTALWORKS OF SKOKIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NITTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-755-0816
Mailing Address - Street 1:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:216-584-1030
Practice Address - Street 1:9312 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1309
Practice Address - Country:US
Practice Address - Phone:216-584-1000
Practice Address - Fax:216-584-1030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTALONE PARTNERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-04
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0225571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty