MEDICARE: KEROLOS ZAKLAMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	35636	TX

General Provider Information

NPI Number	:	1245885573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEROLOS ZAKLAMA

Provider Business Mailing Address
First Line	:	3980 BOAT CLUB RD STE 114
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3206
Country	:	US
Telephone Number	:	817-237-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 BOAT CLUB RD STE 114
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3206
Country	:	US
Telephone Number	:	817-237-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/05/2019

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Directions to “ KEROLOS ZAKLAMA ” Practice Location

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