MEDICARE: Z DENTAL CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1407593023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	Z DENTAL CARE LLC

Provider Business Mailing Address
First Line	:	5621 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5621 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1830
Country	:	US
Telephone Number	:	773-427-1000
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	MONA MANN
Credential	:
Telephone Number	:	630-697-8105

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/16/2022

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Directions to “Z DENTAL CARE LLC ” Practice Location

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