Provider Demographics
NPI:1821537036
Name:ZION DENTAL LLC
Entity Type:Organization
Organization Name:ZION DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMAR
Authorized Official - Middle Name:HEMANT
Authorized Official - Last Name:PATTANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-728-9330
Mailing Address - Street 1:134 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1802
Mailing Address - Country:US
Mailing Address - Phone:262-728-9330
Mailing Address - Fax:
Practice Address - Street 1:2671 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2628
Practice Address - Country:US
Practice Address - Phone:847-872-4782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031025122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty