Provider Demographics
NPI:1508909573
Name:ZUCK, TAMI L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMI
Middle Name:L
Last Name:ZUCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 WYNGATE LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1445
Mailing Address - Country:US
Mailing Address - Phone:847-215-9018
Mailing Address - Fax:815-444-8841
Practice Address - Street 1:360 N TERRA COTTA RD
Practice Address - Street 2:SUITE #D
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3749
Practice Address - Country:US
Practice Address - Phone:815-477-0770
Practice Address - Fax:815-444-8841
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice