Provider Demographics
NPI:1942972716
Name:AZAM, ZAINA (DDS)
Entity Type:Individual
Prefix:
First Name:ZAINA
Middle Name:
Last Name:AZAM
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 1:6211 CHASE RD STE B
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2405
Mailing Address - Country:US
Mailing Address - Phone:313-769-5850
Mailing Address - Fax:
Practice Address - Street 1:6211 CHASE RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2405
Practice Address - Country:US
Practice Address - Phone:313-769-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist