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General NPI Number Information
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NPI Number | 1154758076
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Entity Type | Individual
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Provider Name | TAREK HASSAN ELZAWAHRY DMD
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Gender | Male
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 311 AIRPORT RD
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City | PANAMA CITY
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State | FL
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Zip | 32405-4607
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Country | US
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Telephone | 850-914-0550
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Fax | 850-914-8511
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Provider Business Mailing Address
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Address Line | 2913 KINGS HARBOUR RD
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City | PANAMA CITY
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State | FL
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Zip | 32405-1628
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Country | US
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Telephone | 850-914-0550
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Fax | 850-914-8511
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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 | DN14287
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License Number State | FL
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