Provider Demographics
NPI:1669013355
Name:JIWANI, ZOHEB (DMD)
Entity Type:Individual
Prefix:
First Name:ZOHEB
Middle Name:
Last Name:JIWANI
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 1:1113 RUSHING PARC DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-6751
Mailing Address - Country:US
Mailing Address - Phone:205-401-5767
Mailing Address - Fax:
Practice Address - Street 1:1598 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-4525
Practice Address - Country:US
Practice Address - Phone:205-582-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL67141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice