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General NPI Number Information
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NPI Number | 1902092075
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Entity Type | Individual
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Provider Name | ZACK HICHAM MEKOUAR D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 13900 NOBLEWOOD PLZ
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1449
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Country | US
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Telephone | 703-347-1282
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Fax |
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Provider Business Mailing Address
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Address Line | 9616 GEORGETOWN PIKE
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City | GREAT FALLS
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State | VA
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Zip | 22066-2638
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Country | US
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Telephone | 703-347-1282
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401411070
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN1000523
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 13390
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License Number State | MD
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