Provider Demographics
NPI:1316061567
Name:ZAIBAK, ZACK O (MS DDS)
Entity type:Individual
Prefix:DR
First Name:ZACK
Middle Name:O
Last Name:ZAIBAK
Suffix:
Gender:M
Credentials:MS DDS
Other - Prefix:DR
Other - First Name:ZYAD
Other - Middle Name:O
Other - Last Name:ZAIBAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS DDS
Mailing Address - Street 1:6828 W 171ST ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PK
Mailing Address - State:IL
Mailing Address - Zip Code:60477
Mailing Address - Country:US
Mailing Address - Phone:708-802-9600
Mailing Address - Fax:708-802-9826
Practice Address - Street 1:6828 W 171ST ST
Practice Address - Street 2:
Practice Address - City:TINLEY PK
Practice Address - State:IL
Practice Address - Zip Code:60477
Practice Address - Country:US
Practice Address - Phone:708-802-9600
Practice Address - Fax:708-802-9826
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9181243Medicaid