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General NPI Number Information
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NPI Number | 1114044526
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Entity Type | Individual
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Provider Name | MICHELLE N ZMICK D.D,S,
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5246 RFD
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City | LONG GROVE
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State | IL
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Zip | 60047-9794
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Country | US
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Telephone | 847-821-1696
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Fax | 847-821-1875
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Provider Business Mailing Address
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Address Line | 5246 RFD
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City | LONG GROVE
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State | IL
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Zip | 60047-9794
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Country | US
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Telephone | 847-821-1696
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Fax | 847-821-1875
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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 | 019-0016706
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 021-1093
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License Number State | IL
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