Healthcare Provider Details

I. General information

NPI: 1821208489
Provider Name (Legal Business Name): ZINEB MEDIOUNI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 N DALE MABRY HWY STE 102
TAMPA FL
33618-2075
US

IV. Provider business mailing address

14502 N DALE MABRY HWY STE 102
TAMPA FL
33618-2075
US

V. Phone/Fax

Practice location:
  • Phone: 813-513-5045
  • Fax: 813-513-5075
Mailing address:
  • Phone: 813-513-5045
  • Fax: 813-513-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN18185
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8M886141
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: