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General NPI Number Information
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NPI Number | 1013565084
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Entity Type | Individual
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Provider Name | DR. ZACHARY EDSEY
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Gender | Male
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 290 SPRINGFIELD DR
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2214
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Country | US
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Telephone | 630-980-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 225 GRAND BLVD
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City | PARK RIDGE
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State | IL
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Zip | 60068-3313
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.032123
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License Number State | IL
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