Provider Demographics
NPI:1992834485
Name:PAYAM ZAREI DDS-WEST VILLAGE DENTAL PC
Entity Type:Organization
Organization Name:PAYAM ZAREI DDS-WEST VILLAGE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAREI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-772-7755
Mailing Address - Street 1:2222 W DIVISION ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2717
Mailing Address - Country:US
Mailing Address - Phone:773-772-7755
Mailing Address - Fax:773-772-7766
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 125
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-772-7755
Practice Address - Fax:773-772-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019235801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty