Provider Demographics
NPI:1366169419
Name:ISAYEVA, ZHALA
Entity type:Individual
Prefix:DR
First Name:ZHALA
Middle Name:
Last Name:ISAYEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 ACORN PARK DR APT 5415
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1437
Mailing Address - Country:US
Mailing Address - Phone:781-267-8284
Mailing Address - Fax:
Practice Address - Street 1:20 HOLLAND ST STE 400
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2749
Practice Address - Country:US
Practice Address - Phone:617-326-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist