Provider Demographics
NPI:1538342258
Name:ZAW PROFESSIONAL DENTAL, CORP.
Entity type:Organization
Organization Name:ZAW PROFESSIONAL DENTAL, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-741-8986
Mailing Address - Street 1:126 W EL NORTE PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2502
Mailing Address - Country:US
Mailing Address - Phone:760-741-8986
Mailing Address - Fax:760-741-8987
Practice Address - Street 1:126 W EL NORTE PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-2502
Practice Address - Country:US
Practice Address - Phone:760-741-8986
Practice Address - Fax:760-741-8987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38087261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental