=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841582442
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZABETH ZAUN, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2011
-----------------------------------------------------
Last Update Date | 05/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1480 N ORCHARD RD STE 104
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506-7940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-708-7334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 714 N FORDHAM AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506-2715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-971-2207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MR. CHRIS MOUW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-484-1021
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 019.028442
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------