Provider Demographics
NPI:1154584621
Name:ZALE FAMILY DENTISTRY, P.C.
Entity type:Organization
Organization Name:ZALE FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZALE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-462-4040
Mailing Address - Street 1:2081 CALISTOGA DR STE 3S
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-4834
Mailing Address - Country:US
Mailing Address - Phone:815-462-4040
Mailing Address - Fax:815-462-4073
Practice Address - Street 1:2081 CALISTOGA DR STE 3S
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-4834
Practice Address - Country:US
Practice Address - Phone:815-462-4040
Practice Address - Fax:815-462-4073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-05
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0253861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty