MEDICARE: M. ZAKER DDS INC

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	122300000X	Dentist	57220	CA

General Provider Information

NPI Number	:	1760939912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. ZAKER DDS INC

Provider Business Mailing Address
First Line	:	8880 LIMONITE AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-5021
Country	:	US
Telephone Number	:	800-881-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	8880 LIMONITE AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-5021
Country	:	US
Telephone Number	:	800-881-0393
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MEYSAM ZAKER
Credential	:	DDS
Telephone Number	:	800-881-0393

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/06/2016

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