MEDICARE: RASHEED M ZAHAWI DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	34301	TX

General Provider Information

NPI Number	:	1447782057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RASHEED M ZAHAWI DMD

Provider Business Mailing Address
First Line	:	70 CREEK LN
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-7330
Country	:	US
Telephone Number	:	707-225-1016
Fax Number	:

Provider Business Practice Location Address
First Line	:	4625 BOAT CLUB RD STE 225
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7023
Country	:	US
Telephone Number	:	817-237-8177
Fax Number	:

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

Provider Enumeration Date	:	04/02/2017
Last Update Date	:	09/29/2021

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