Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0401412713 | VA |
N | 1223P0221X | Pediatric Dentist | 60294023 | WA |
Y | 1223P0221X | Pediatric Dentist | D010986 | AZ |
NPI | 1063769818 |
---|---|
Provider Name | Dr. Takish Ziad |
First Address | Casa Grande, AZ 85130-0020 |
Second Address | Casa Grande, AZ 85122-5504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2012 |
Last Update Date | 02/02/2022 |