Provider Demographics
NPI:1811190499
Name:ZOLADZ, MARISSA ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:ANNE
Last Name:ZOLADZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11940 LYNCH DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4435
Mailing Address - Country:US
Mailing Address - Phone:708-278-4572
Mailing Address - Fax:
Practice Address - Street 1:160 E WEND ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4438
Practice Address - Country:US
Practice Address - Phone:630-257-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice