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General NPI Number Information
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NPI Number | 1649575630
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Entity Type | Organization
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Legal Business Name | OFFICE ANESTHESIOLOGY AND DENTAL CONSULTANTS, PC
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 427 W WINDSOR AVE
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City | LOMBARD
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State | IL
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Zip | 60148-2129
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Country | US
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Telephone | 630-620-9199
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Fax | 877-620-5899
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Provider Business Mailing Address
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Address Line | 427 W WINDSOR AVE
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City | LOMBARD
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State | IL
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Zip | 60148-2129
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Country | US
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Telephone | 630-620-9199
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Fax | 877-620-5899
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ZAKARIA S MESSIEHA
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Credential | DDSANESTHESIOLOGIST
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Telephone | 630-620-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 137-000423
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 019024338
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 12011109A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 319014980
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 137000423
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License Number State | IL
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