Provider Demographics
NPI:1841366614
Name:ZAKI, TAREK OSMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TAREK
Middle Name:OSMAN
Last Name:ZAKI
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 1:2029 LYNNHAVEN PKWY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1474
Mailing Address - Country:US
Mailing Address - Phone:757-416-1100
Mailing Address - Fax:757-416-1130
Practice Address - Street 1:2029 LYNNHAVEN PKWY
Practice Address - Street 2:SUITE 700
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1474
Practice Address - Country:US
Practice Address - Phone:757-416-1100
Practice Address - Fax:757-416-1130
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010068041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA265213Medicaid