Healthcare Provider Details

I. General information

NPI: 1265809388
Provider Name (Legal Business Name): ZAID ATARCHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HALSTED LN
AURORA IL
60503-5786
US

IV. Provider business mailing address

2301 HALSTED LN
AURORA IL
60503-5786
US

V. Phone/Fax

Practice location:
  • Phone: 773-334-8274
  • Fax:
Mailing address:
  • Phone: 773-334-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number021002758
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number34738
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019030413
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: