Provider Demographics
NPI:1568886315
Name:ISSA, ZAIN ALQAWS KAMAL (DDS)
Entity Type:Individual
Prefix:
First Name:ZAIN ALQAWS
Middle Name:KAMAL
Last Name:ISSA
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 1:445 WILLARD ST UNIT 205
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6467
Mailing Address - Country:US
Mailing Address - Phone:803-389-8926
Mailing Address - Fax:
Practice Address - Street 1:166 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02121-3411
Practice Address - Country:US
Practice Address - Phone:617-445-9880
Practice Address - Fax:617-445-5746
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1856455122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist