Provider Demographics
NPI:1558791079
Name:ZAK DENTAL CORP
Entity Type:Organization
Organization Name:ZAK DENTAL CORP
Other - Org Name:DR. ZAK LONG BEACH DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-706-5273
Mailing Address - Street 1:3620 LONG BEACH BLVD
Mailing Address - Street 2:SUITE B6
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4022
Mailing Address - Country:US
Mailing Address - Phone:562-426-6458
Mailing Address - Fax:310-734-1546
Practice Address - Street 1:3620 LONG BEACH BLVD
Practice Address - Street 2:SUITE B6
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4022
Practice Address - Country:US
Practice Address - Phone:562-426-6458
Practice Address - Fax:310-734-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty