Healthcare Provider Details

I. General information

NPI: 1497884985
Provider Name (Legal Business Name): PAYAM ZAREI DDS-BERKELEY DENTAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 N TAFT AVE
BERKELEY IL
60163-1555
US

IV. Provider business mailing address

1752 N TAFT AVE
BERKELEY IL
60163-1555
US

V. Phone/Fax

Practice location:
  • Phone: 708-449-8683
  • Fax: 708-449-8806
Mailing address:
  • Phone: 708-449-8683
  • Fax: 708-449-8806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. PAYAM ZAREI
Title or Position: PRESIDENT
Credential: DDS
Phone: 708-449-8683