MEDICARE: DENTAL HEIGHTS DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center
2	122300000X	Dentist	019028083	IL

General Provider Information

NPI Number	:	1063754232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HEIGHTS DDS PC

Provider Business Mailing Address
First Line	:	148 EAST ARMY TRAIL ROAD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139
Country	:	US
Telephone Number	:	708-369-6232
Fax Number	:

Provider Business Practice Location Address
First Line	:	148 EAST ARMY TRAIL ROAD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139
Country	:	US
Telephone Number	:	708-369-6232
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. ZISHAN BADER
Credential	:	DDS
Telephone Number	:	708-369-6232

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	12/07/2023

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