Provider Demographics
NPI:1114510716
Name:MUSTACCHI, ZAKI (DDS)
Entity type:Individual
Prefix:DR
First Name:ZAKI
Middle Name:
Last Name:MUSTACCHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ROUTE 70 STE 8
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5961
Mailing Address - Country:US
Mailing Address - Phone:848-245-0779
Mailing Address - Fax:848-245-0780
Practice Address - Street 1:1000 ROUTE 70 STE 8
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5961
Practice Address - Country:US
Practice Address - Phone:848-245-0779
Practice Address - Fax:848-245-0780
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN260581223P0221X
NJ22DI028523001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0826251Medicaid