Healthcare Provider Details

I. General information

NPI: 1811630585
Provider Name (Legal Business Name): MOAYAD ADNAN ZAWAHRA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S IDAHO RD STE 100
APACHE JUNCTION AZ
85119-0006
US

IV. Provider business mailing address

4906 E BROWN RD UNIT 8
MESA AZ
85205-4263
US

V. Phone/Fax

Practice location:
  • Phone: 480-867-4586
  • Fax:
Mailing address:
  • Phone: 313-415-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD011456
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: