Healthcare Provider Details

I. General information

NPI: 1063754232
Provider Name (Legal Business Name): DENTAL HEIGHTS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 EAST ARMY TRAIL ROAD
GLENDALE HEIGHTS IL
60139
US

IV. Provider business mailing address

148 EAST ARMY TRAIL ROAD
GLENDALE HEIGHTS IL
60139
US

V. Phone/Fax

Practice location:
  • Phone: 708-369-6232
  • Fax:
Mailing address:
  • Phone: 708-369-6232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028083
License Number StateIL

VIII. Authorized Official

Name: DR. ZISHAN BADER
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 708-369-6232