Provider Demographics
NPI:1578859807
Name:ZAHR, RENNA HAZBOUN (DMD)
Entity Type:Individual
Prefix:
First Name:RENNA
Middle Name:HAZBOUN
Last Name:ZAHR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20408 COULSON ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6828
Mailing Address - Country:US
Mailing Address - Phone:267-738-5538
Mailing Address - Fax:
Practice Address - Street 1:11980 SAN VICENTE BLVD SUITE 980
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1003
Practice Address - Country:US
Practice Address - Phone:310-826-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA62199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program