Provider Demographics
NPI:1689194847
Name:KHERALUWALA, ZEENAT ABDULALI (DDS)
Entity Type:Individual
Prefix:
First Name:ZEENAT
Middle Name:ABDULALI
Last Name:KHERALUWALA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ZEENAT
Other - Middle Name:MUSTAFA
Other - Last Name:ABDULALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6010 BUSHNELL DR APT 733
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5830
Mailing Address - Country:US
Mailing Address - Phone:469-230-4839
Mailing Address - Fax:
Practice Address - Street 1:325 ADAMS DR STE 335
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6742
Practice Address - Country:US
Practice Address - Phone:682-803-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32933OtherSTATE BOARD OF DENTAL EXAMINERS