Healthcare Provider Details

I. General information

NPI: 1992151518
Provider Name (Legal Business Name): LAVI ZARET D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 GOLF RD STE 550
SKOKIE IL
60076-1269
US

IV. Provider business mailing address

2943 W JARVIS AVE
CHICAGO IL
60645-1207
US

V. Phone/Fax

Practice location:
  • Phone: 847-328-9900
  • Fax:
Mailing address:
  • Phone: 773-308-3519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.031092
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: