Provider Demographics
NPI:1013367846
Name:ZAYTOUN, MARY LANIER
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LANIER
Last Name:ZAYTOUN
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 1:5041 SIX FORKS RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4493
Mailing Address - Country:US
Mailing Address - Phone:919-782-6911
Mailing Address - Fax:
Practice Address - Street 1:5041 SIX FORKS RD
Practice Address - Street 2:SUITE #200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4493
Practice Address - Country:US
Practice Address - Phone:919-782-6911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist