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General NPI Number Information
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NPI Number | 1275919094
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Entity Type | Organization
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Legal Business Name | DR. ZASSO & ASSOCIATES (SKOKIE), LTD.
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 9312 SKOKIE BLVD
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City | SKOKIE
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State | IL
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Zip | 60077-1309
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Country | US
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Telephone | 216-584-1000
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Fax | 216-584-1030
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Provider Business Mailing Address
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Address Line | PO BOX 860036
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-0036
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Country | US
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Telephone |
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Fax | 216-584-1030
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Authorized Official
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Title or Position | MANAGER CREDENTIALING
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Name | RACHEL NITTINGER
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Credential |
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Telephone | 972-755-0816
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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 | 019.022557
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License Number State | IL
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