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General NPI Number Information
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NPI Number | 1629633037
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Entity Type | Organization
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Legal Business Name | I ZAK DDS PROF DENTAL CORP
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 3383 TELEGRAPH RD
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City | VENTURA
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State | CA
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Zip | 93003-3312
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Country | US
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Telephone | 805-644-9501
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Fax | 805-644-1108
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Provider Business Mailing Address
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Address Line | 10501 LAKEWOOD BLVD
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City | DOWNEY
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State | CA
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Zip | 90241-2709
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Country | US
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Telephone | 805-426-9587
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Fax | 805-521-4707
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Authorized Official
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Title or Position | CEO
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Name | ILYA ZAK
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Credential | DDS
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Telephone | 661-253-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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