Provider Demographics
NPI:1154758076
Name:ELZAWAHRY, TAREK HASSAN (DMD)
Entity type:Individual
Prefix:DR
First Name:TAREK
Middle Name:HASSAN
Last Name:ELZAWAHRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 KINGS HARBOUR RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-1628
Mailing Address - Country:US
Mailing Address - Phone:850-914-0550
Mailing Address - Fax:850-914-8511
Practice Address - Street 1:311 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4607
Practice Address - Country:US
Practice Address - Phone:850-914-0550
Practice Address - Fax:850-914-8511
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN142871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice