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General NPI Number Information
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NPI Number | 1154010361
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Entity Type | Individual
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Provider Name | SYEDA MARYAM ZEHRA DMD
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Gender | Female
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 167 CLARKSON EXECUTIVE PARK
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City | ELLISVILLE
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State | MO
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Zip | 63011-2176
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Country | US
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Telephone | 866-988-4504
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Fax |
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Provider Business Mailing Address
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Address Line | 16455 WILDHORSE LAKE BLVD APT 143
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City | CHESTERFIELD
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State | MO
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Zip | 63005-4248
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Country | US
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Telephone | 201-508-7432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2024048570
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License Number State | MO
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