Provider Demographics
NPI:1982060547
Name:ZIEBA DENTISTRY HIGHLAND PARK,LTD
Entity Type:Organization
Organization Name:ZIEBA DENTISTRY HIGHLAND PARK,LTD
Other - Org Name:WEBSTER DENTAL CARE HIGHLAND PARK LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZIEBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-456-8835
Mailing Address - Street 1:2685 WAUKEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1430
Mailing Address - Country:US
Mailing Address - Phone:847-432-1111
Mailing Address - Fax:847-432-3201
Practice Address - Street 1:2685 WAUKEGAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-1430
Practice Address - Country:US
Practice Address - Phone:847-432-1111
Practice Address - Fax:847-432-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190265071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty