MEDICARE: DR. DALAL ZAKKO DDS

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	1223G0001X	General Practice Dentistry	DN 15524	FL

General Provider Information

NPI Number	:	1851454821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALAL ZAKKO DDS

Provider Business Mailing Address
First Line	:	2633 E COMMERCIAL BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4135
Country	:	US
Telephone Number	:	954-776-4720
Fax Number	:	954-489-0004

Provider Business Practice Location Address
First Line	:	2633 E COMMERCIAL BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4135
Country	:	US
Telephone Number	:	954-776-4720
Fax Number	:	954-489-0004

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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