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General NPI Number Information
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NPI Number | 1063754232
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Entity Type | Organization
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Legal Business Name | DENTAL HEIGHTS DDS PC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 148 EAST ARMY TRAIL ROAD
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City | GLENDALE HEIGHTS
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State | IL
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Zip | 60139
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Country | US
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Telephone | 708-369-6232
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Fax |
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Provider Business Mailing Address
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Address Line | 148 EAST ARMY TRAIL ROAD
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City | GLENDALE HEIGHTS
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State | IL
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Zip | 60139
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Country | US
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Telephone | 708-369-6232
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. ZISHAN BADER
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Credential | DDS
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Telephone | 708-369-6232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028083
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License Number State | IL
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