Irene Sea Haddock Zillich, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

2901020004 Issued in MI

Practice address

1793 W Stadium Blvd
Ann Arbor, MI 48103-5288

Phone

(734) 662-3222

NPI assigned

Aug 10, 2010

Last updated

Jul 10, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Irene Sea Haddock Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ann Arbor Smiles Haddock PLLC

  • Dentist
  • Ann Arbor, MI
  • NPI 1922506674
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341878400000",
    "number": "1538474986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1793 W STADIUM BLVD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481035288",
            "telephone_number": "734-662-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1793 W STADIUM BLVD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481035288",
            "telephone_number": "734-662-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZILLICH",
        "first_name": "IRENE",
        "middle_name": "SEA HADDOCK",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-10",
        "last_updated": "2012-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020004",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN-10206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IRENE",
            "last_name": "HADDOCK",
            "middle_name": "SEA",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joel David Ziettlow, CRNA
• Adam M Ziff, DO
• Madison Ziga, PA-S
• Allison Zilch
• Vicki Zilke, CNP
• Richard Martin Zillich, DDS, MS
• Christopher Zimecki, CRNA
• Matthew T. Zimmer, MSW
• Natalie Zimmer
• Zachary Zimmer

• Dentist in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.