Healthcare Provider Details

I. General information

NPI: 1538908488
Provider Name (Legal Business Name): DR. NIKI ZOKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 MAIN ST
COLLEGE PARK GA
30337-3655
US

IV. Provider business mailing address

701 N ELM DR
BEVERLY HILLS CA
90210-3422
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-6775
  • Fax:
Mailing address:
  • Phone: 818-422-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS110868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: