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General NPI Number Information
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NPI Number | 1154573558
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Entity Type | Organization
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Legal Business Name | DENT-SURE DENTAL SERVICES, P.C.
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 3942 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60655-4033
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Country | US
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Telephone | 773-779-4499
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Fax |
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Provider Business Mailing Address
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Address Line | 3942 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60655-4033
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Country | US
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Telephone | 773-779-4499
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JEFFREY S ZELLER
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Credential | D.D.S.
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Telephone | 773-779-4499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 060.008435
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License Number State | IL
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