Healthcare Provider Details

I. General information

NPI: 1972201275
Provider Name (Legal Business Name): ZAYNA JAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 VANCINA LN
NEW LENOX IL
60451-9531
US

IV. Provider business mailing address

1365 35TH ST
DOWNERS GROVE IL
60515-1417
US

V. Phone/Fax

Practice location:
  • Phone: 815-348-9617
  • Fax:
Mailing address:
  • Phone: 630-765-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.034949
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: