Provider Demographics
NPI:1013214642
Name:ZAU, PAUL DOREL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DOREL
Last Name:ZAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:ZAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4851 HAZELTINE AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2341
Mailing Address - Country:US
Mailing Address - Phone:818-571-8547
Mailing Address - Fax:
Practice Address - Street 1:6857 RESEDA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4228
Practice Address - Country:US
Practice Address - Phone:818-343-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice