Provider Demographics
NPI:1639241755
Name:ZOUAK, LARBI (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARBI
Middle Name:
Last Name:ZOUAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-6 DEPOT SQ
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2809
Mailing Address - Country:US
Mailing Address - Phone:201-816-1881
Mailing Address - Fax:201-816-1751
Practice Address - Street 1:4-6 DEPOT SQ
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2809
Practice Address - Country:US
Practice Address - Phone:201-816-1881
Practice Address - Fax:201-816-1751
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI172421223G0001X
NY042671-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice