Provider Demographics
NPI:1578095097
Name:ADVANCED PERIODONTICS CENTER
Entity Type:Organization
Organization Name:ADVANCED PERIODONTICS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZITOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-651-9341
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51502-0189
Mailing Address - Country:US
Mailing Address - Phone:712-435-0992
Mailing Address - Fax:402-552-2330
Practice Address - Street 1:320 MCKENZIE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1002
Practice Address - Country:US
Practice Address - Phone:712-435-0992
Practice Address - Fax:402-552-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty