Provider Demographics
NPI:1457845125
Name:I ZAK DDS PROF DENTAL CORP
Entity Type:Organization
Organization Name:I ZAK DDS PROF DENTAL CORP
Other - Org Name:DR. ZAK DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / DENTAL DIRECT
Authorized Official - Prefix:
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-862-2341
Mailing Address - Street 1:443 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2435
Mailing Address - Country:US
Mailing Address - Phone:310-706-5273
Mailing Address - Fax:
Practice Address - Street 1:1161 PARK VIEW DR STE 100
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3757
Practice Address - Country:US
Practice Address - Phone:909-599-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38238OtherDENTAL LICENSE