Provider Demographics
NPI:1114351392
Name:ZAMAN, MOHAMMAD KHAIRUZ (BDS MS)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:KHAIRUZ
Last Name:ZAMAN
Suffix:
Gender:M
Credentials:BDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 WINDING CV
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6376
Mailing Address - Country:US
Mailing Address - Phone:407-922-9872
Mailing Address - Fax:
Practice Address - Street 1:158 LOOKOUT PL STE 101
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4411
Practice Address - Country:US
Practice Address - Phone:407-682-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-24
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN199431223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics