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General NPI Number Information
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NPI Number | 1487063053
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Entity Type | Individual
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Provider Name | MINA ZAKI
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Gender | Male
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 1100 CHURCH RD W STE 119
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City | SOUTHAVEN
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State | MS
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Zip | 38671-7154
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Country | US
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Telephone | 662-253-8027
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Fax | 662-253-8067
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Provider Business Mailing Address
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Address Line | 1100 CHURCH RD W STE 119
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City | SOUTHAVEN
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State | MS
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Zip | 38671-7154
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Country | US
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Telephone | 662-253-8027
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Fax | 662-253-8067
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 3770-14
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License Number State | MS
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