Provider Demographics
NPI:1861509523
Name:ELLOWAY, ZAKAR L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZAKAR
Middle Name:L
Last Name:ELLOWAY
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 1:1419 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1401
Mailing Address - Country:US
Mailing Address - Phone:928-774-4640
Mailing Address - Fax:928-774-4819
Practice Address - Street 1:1419 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1401
Practice Address - Country:US
Practice Address - Phone:928-774-4640
Practice Address - Fax:928-774-4819
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice