Provider Demographics
NPI:1760883979
Name:ZAKIYEV, RUSTAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUSTAM
Middle Name:
Last Name:ZAKIYEV
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 1:114 GOTTHARDT ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3104
Mailing Address - Country:US
Mailing Address - Phone:732-322-7640
Mailing Address - Fax:
Practice Address - Street 1:114 GOTTHARDT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3104
Practice Address - Country:US
Practice Address - Phone:732-322-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-07
Last Update Date:2014-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02576400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist