Provider Demographics
NPI:1013579549
Name:ZAKI, OMAR
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ZAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15844 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1114
Mailing Address - Country:US
Mailing Address - Phone:810-394-8063
Mailing Address - Fax:
Practice Address - Street 1:6760 ALLEN RD STE 101
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2062
Practice Address - Country:US
Practice Address - Phone:313-928-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-04
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist