Provider Demographics
NPI:1558687293
Name:ZAHURULLAH, AYESHA NAUREEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:NAUREEN
Last Name:ZAHURULLAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MERIDIAN AVE E APT M208
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98371-1088
Mailing Address - Country:US
Mailing Address - Phone:248-790-7355
Mailing Address - Fax:
Practice Address - Street 1:10011 BRIDGEPORT WAY SW STE 700
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2350
Practice Address - Country:US
Practice Address - Phone:253-215-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010201061223G0001X
IL0190282281223G0001X
WADE611002911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice