Provider Demographics
NPI:1356701668
Name:ZELDA DENTAL
Entity type:Organization
Organization Name:ZELDA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:MALKAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-245-7872
Mailing Address - Street 1:1807 MERLIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3131
Mailing Address - Country:US
Mailing Address - Phone:979-245-7872
Mailing Address - Fax:
Practice Address - Street 1:1807 MERLIN ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3131
Practice Address - Country:US
Practice Address - Phone:979-245-7872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty