Healthcare Provider Details

I. General information

NPI: 1649575630
Provider Name (Legal Business Name): OFFICE ANESTHESIOLOGY AND DENTAL CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W WINDSOR AVE
LOMBARD IL
60148-2129
US

IV. Provider business mailing address

427 W WINDSOR AVE
LOMBARD IL
60148-2129
US

V. Phone/Fax

Practice location:
  • Phone: 630-620-9199
  • Fax: 877-620-5899
Mailing address:
  • Phone: 630-620-9199
  • Fax: 877-620-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number019024338
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number12011109A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number319014980
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number137000423
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number137-000423
License Number StateIL

VIII. Authorized Official

Name: DR. ZAKARIA S MESSIEHA
Title or Position: PRESIDENT
Credential: DDSANESTHESIOLOGIST
Phone: 630-620-9199