Provider Demographics
NPI:1205091444
Name:ZIZIC, KIMBERLY (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:ZIZIC
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 1:800 S MILWAUKEE AVE
Mailing Address - Street 2:#103
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-367-6654
Mailing Address - Fax:847-367-6671
Practice Address - Street 1:800 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3254
Practice Address - Country:US
Practice Address - Phone:847-367-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist