Provider Demographics
NPI:1427247055
Name:MOHAMED, ZAKIA S (DDS)
Entity type:Individual
Prefix:
First Name:ZAKIA
Middle Name:S
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 NATIONAL DR STE 315
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-1095
Mailing Address - Country:US
Mailing Address - Phone:972-668-4696
Mailing Address - Fax:972-408-4157
Practice Address - Street 1:3465 NATIONAL DR STE 315
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-1095
Practice Address - Country:US
Practice Address - Phone:972-668-4696
Practice Address - Fax:972-408-4157
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29666122300000X, 122300000X
CT80367301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2187288Medicaid
CT008036730Medicaid
CT009747OtherSTATE LICENSE