Provider Demographics
NPI:1841795291
Name:ZAIBAK, MANAL (DDS)
Entity Type:Individual
Prefix:
First Name:MANAL
Middle Name:
Last Name:ZAIBAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ELTON HILLS LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3602
Mailing Address - Country:US
Mailing Address - Phone:507-288-8363
Mailing Address - Fax:
Practice Address - Street 1:116 ELTON HILLS LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3602
Practice Address - Country:US
Practice Address - Phone:507-288-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS1611223E0200X
MI29010225281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice