Provider Demographics
NPI:1376847137
Name:IRVING PARK DENTISTRY, INC.
Entity Type:Organization
Organization Name:IRVING PARK DENTISTRY, INC.
Other - Org Name:ZAYZAFOON DENTAL CARE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYZAFOON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:312-919-6266
Mailing Address - Street 1:1933 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5180
Mailing Address - Country:US
Mailing Address - Phone:312-919-6266
Mailing Address - Fax:
Practice Address - Street 1:1933 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5180
Practice Address - Country:US
Practice Address - Phone:312-919-6266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty