MEDICARE: KARIM MAGID ZAKLAMA DENTAL CORPORATION

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

General Provider Information

NPI Number	:	1639943889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARIM MAGID ZAKLAMA DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 920050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75392-0050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	678 W ARROW HWY
Second Line	:
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-2958
Country	:	US
Telephone Number	:	909-643-8007
Fax Number	:	909-654-3031

Authorized Official
Title or Position	:	OWNER
Name	:	KARIM ZAKLAMA
Credential	:	DDS
Telephone Number	:	909-643-8007

Provider Enumeration Date	:	11/08/2023
Last Update Date	:	11/08/2023

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