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NPI Code Detail

MEDICARE: MUSTAFA ZAKKOOM

MEDICARE: MUSTAFA ZAKKOOM
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
1122300000XDentist2901021277MI
21223G0001XGeneral Practice DentistryDN1856872MA

General Provider Information

NPI Number : 1952715591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MUSTAFA ZAKKOOM
Provider Business Mailing Address
First Line : 232 UNION ST
Second Line :
City : LYNN
State : MA
Zip : 01901-1315
Country : US
Telephone Number : 248-824-4916
Fax Number :
Provider Business Practice Location Address
First Line : 1096 REVERE BEACH PKWY
Second Line :
City : CHELSEA
State : MA
Zip : 02150-1454
Country : US
Telephone Number : 248-824-4916
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2014
Last Update Date : 04/23/2019

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Directions to “ MUSTAFA ZAKKOOM ” Practice Location

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