Ziad Kutob, DDS
Individual provider Active NPI Dentist · Lakeland, TN
NPI 1912698176 · NPPES record last updated Sep 27, 2023
Key facts
- NPI
- 1912698176
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN123133 (GA)
- Practice address
- 8950 US Highway 64 Ste 108
Lakeland, TN 38002-4566 - Phone
- (734) 741-3588
- NPI assigned
- May 18, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN123133 | GA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN123133 | GA | Yes |
Addresses
Primary practice location
8950 US Highway 64 Ste 108
Lakeland, TN 38002-4566
Mailing address
8950 US Highway 64
Lakeland, TN 38002-4566
Other providers in Lakeland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.