Healthcare Provider Details

I. General information

NPI: 1114044526
Provider Name (Legal Business Name): MICHELLE N ZMICK D.D,S,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5246 RFD
LONG GROVE IL
60047-9794
US

IV. Provider business mailing address

5246 RFD
LONG GROVE IL
60047-9794
US

V. Phone/Fax

Practice location:
  • Phone: 847-821-1696
  • Fax: 847-821-1875
Mailing address:
  • Phone: 847-821-1696
  • Fax: 847-821-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019-0016706
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number021-1093
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: