Healthcare Provider Details

I. General information

NPI: 1821882200
Provider Name (Legal Business Name): ZAINA ALSADAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3098
US

IV. Provider business mailing address

182 KIRBY AVE
LACKAWANNA NY
14218-3156
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-3189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065777
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: