Provider Demographics
NPI:1790521607
Name:ZIEGENHORN, ELISE (DMD)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:
Last Name:ZIEGENHORN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 W HUNTING CT
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6682
Mailing Address - Country:US
Mailing Address - Phone:847-707-6703
Mailing Address - Fax:
Practice Address - Street 1:780 LEE ST FL 2
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6459
Practice Address - Country:US
Practice Address - Phone:847-264-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0352981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice