Healthcare Provider Details

I. General information

NPI: 1285300962
Provider Name (Legal Business Name): ZENA SAKKA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 TIMBER LANE DR
FLUSHING MI
48433-3513
US

IV. Provider business mailing address

PO BOX 526926
MIAMI FL
33152-6926
US

V. Phone/Fax

Practice location:
  • Phone: 810-853-8002
  • Fax:
Mailing address:
  • Phone: 313-380-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901601098
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: