Provider Demographics
NPI:1811097660
Name:BAHRANI, ZAYNEB E (DDS)
Entity type:Individual
Prefix:DR
First Name:ZAYNEB
Middle Name:E
Last Name:BAHRANI
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 1:755 S MILWAUKEE AVE
Mailing Address - Street 2:STE 240
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3253
Mailing Address - Country:US
Mailing Address - Phone:224-206-7060
Mailing Address - Fax:224-513-5782
Practice Address - Street 1:755 S MILWAUKEE AVE
Practice Address - Street 2:STE 240
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3253
Practice Address - Country:US
Practice Address - Phone:224-206-7060
Practice Address - Fax:224-513-5782
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025888122300000X
TX20903122300000X
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist