Healthcare Provider Details

I. General information

NPI: 1164358057
Provider Name (Legal Business Name): ZANE ALI ISSA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MEADOWLARK BLVD
DERBY KS
67037-3465
US

IV. Provider business mailing address

900 E MEADOWLARK BLVD
DERBY KS
67037-3465
US

V. Phone/Fax

Practice location:
  • Phone: 316-788-2118
  • Fax:
Mailing address:
  • Phone: 316-788-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62379
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: