Provider Demographics
NPI:1841807104
Name:ABOU ZAKHEM, YAZAN
Entity Type:Individual
Prefix:
First Name:YAZAN
Middle Name:
Last Name:ABOU ZAKHEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CONSTITUTION CT APT 222
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2924
Mailing Address - Country:US
Mailing Address - Phone:201-640-1046
Mailing Address - Fax:
Practice Address - Street 1:1438 GRAFTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-2721
Practice Address - Country:US
Practice Address - Phone:508-753-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist