Provider Demographics
NPI:1932258738
Name:ZAJAC, JOSEPH MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
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 1:518 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3064
Mailing Address - Country:US
Mailing Address - Phone:630-271-0311
Mailing Address - Fax:630-322-8158
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:630-271-0311
Practice Address - Fax:630-322-8158
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist