Provider Demographics
NPI:1598810830
Name:ZALE FOSTER AND RUGINIS DENTAL
Entity Type:Organization
Organization Name:ZALE FOSTER AND RUGINIS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-838-1998
Mailing Address - Street 1:856 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-2229
Mailing Address - Country:US
Mailing Address - Phone:815-838-1998
Mailing Address - Fax:815-838-4263
Practice Address - Street 1:856 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-2229
Practice Address - Country:US
Practice Address - Phone:815-838-1998
Practice Address - Fax:815-838-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X, 1223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty