Provider Demographics
NPI:1134636574
Name:ZAKIA AZZO, SHUROUK (DDS MPH)
Entity Type:Individual
Prefix:DR
First Name:SHUROUK
Middle Name:
Last Name:ZAKIA AZZO
Suffix:
Gender:F
Credentials:DDS MPH
Other - Prefix:
Other - First Name:CHAROUK
Other - Middle Name:
Other - Last Name:ZAKIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7516 TREVINO DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-6129
Mailing Address - Country:US
Mailing Address - Phone:972-900-2470
Mailing Address - Fax:
Practice Address - Street 1:7516 TREVINO DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-6129
Practice Address - Country:US
Practice Address - Phone:972-900-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist