Provider Demographics
NPI:1154010361
Name:ZEHRA, SYEDA MARYAM (DMD)
Entity type:Individual
Prefix:
First Name:SYEDA
Middle Name:MARYAM
Last Name:ZEHRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16455 WILDHORSE LAKE BLVD APT 143
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4248
Mailing Address - Country:US
Mailing Address - Phone:201-508-7432
Mailing Address - Fax:
Practice Address - Street 1:167 CLARKSON EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2176
Practice Address - Country:US
Practice Address - Phone:866-988-4504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240485701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice