Provider Demographics
NPI:1790819969
Name:ZMICK, CLIFFORD ANTHONY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:ANTHONY
Last Name:ZMICK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3648 INDIAN WELLS LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3102
Mailing Address - Country:US
Mailing Address - Phone:773-745-8300
Mailing Address - Fax:773-745-8385
Practice Address - Street 1:7020 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-4306
Practice Address - Country:US
Practice Address - Phone:773-745-8300
Practice Address - Fax:773-745-8385
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A155721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice