Provider Demographics
NPI:1992455307
Name:AL-ZZBAIRI, SHADHA HUSSEIN HASAN (DDS)
Entity type:Individual
Prefix:MS
First Name:SHADHA
Middle Name:HUSSEIN HASAN
Last Name:AL-ZZBAIRI
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 1:406 CREPEAU ST, APT 103
Mailing Address - Street 2:
Mailing Address - City:SAINT LAURENT
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H4N1N3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PASEO DR CEISO BARBOSA, TERRENO DE CENTRO MEDICO
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401418612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program