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General NPI Number Information
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NPI Number | 1962217869
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Entity Type | Organization
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Legal Business Name | AZ DENTAL PLLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 153 GROVE ST
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City | PUTNAM
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State | CT
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Zip | 06260-2115
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Country | US
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Telephone | 860-928-3723
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Fax |
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Provider Business Mailing Address
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Address Line | 153 GROVE ST
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City | PUTNAM
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State | CT
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Zip | 06260-2115
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Country | US
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Telephone | 860-928-3723
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | YAZAN ABOU ZAKHEM
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Credential |
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Telephone | 201-640-1046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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