Healthcare Provider Details

I. General information

NPI: 1760831465
Provider Name (Legal Business Name): MATTHEW JOSEPH ZIELINSKI D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 05/28/2022
Certification Date: 05/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W PHILLIP RD STE 128
VERNON HILLS IL
60061-1796
US

IV. Provider business mailing address

10 W PHILLIP RD STE 128
VERNON HILLS IL
60061-1796
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-6410
  • Fax:
Mailing address:
  • Phone: 847-367-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number018.001991
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.030875
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: