Provider Demographics
NPI:1629633037
Name:I ZAK DDS PROF DENTAL CORP
Entity Type:Organization
Organization Name:I ZAK DDS PROF DENTAL CORP
Other - Org Name:DR. ZAK VENTURA DENTAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-253-4000
Mailing Address - Street 1:10501 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2709
Mailing Address - Country:US
Mailing Address - Phone:805-426-9587
Mailing Address - Fax:805-521-4707
Practice Address - Street 1:3383 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3312
Practice Address - Country:US
Practice Address - Phone:805-644-9501
Practice Address - Fax:805-644-1108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I ZAK DDS PROF DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-01
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty