Provider Demographics
NPI:1912055179
Name:ZAJAC, JAMES A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:ZAJAC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 LONGMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2329
Mailing Address - Country:US
Mailing Address - Phone:630-964-4567
Mailing Address - Fax:
Practice Address - Street 1:518 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3064
Practice Address - Country:US
Practice Address - Phone:630-271-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2021-03-16
Deactivation Date:2021-03-05
Deactivation Code:
Reactivation Date:2021-03-16
Provider Licenses
StateLicense IDTaxonomies
IL019.0201191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101560OtherDORAL DENTAL SERVICES