Provider Demographics
NPI:1730312836
Name:ZAKHARY, PETER MAGED (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MAGED
Last Name:ZAKHARY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S ZARZAMORA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-4145
Mailing Address - Country:US
Mailing Address - Phone:210-236-9220
Mailing Address - Fax:210-257-0399
Practice Address - Street 1:210 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-4145
Practice Address - Country:US
Practice Address - Phone:210-236-9220
Practice Address - Fax:210-257-0399
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584871223G0001X
TX27221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281652207Medicaid