Provider Demographics
NPI:1932944030
Name:ZAIBAK, MO (DMD)
Entity type:Individual
Prefix:DR
First Name:MO
Middle Name:
Last Name:ZAIBAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MO
Other - Middle Name:
Other - Last Name:ZAIBAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:6828 171ST ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3724
Mailing Address - Country:US
Mailing Address - Phone:708-802-9600
Mailing Address - Fax:
Practice Address - Street 1:6828 171ST ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3724
Practice Address - Country:US
Practice Address - Phone:708-802-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0352841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice