Basic Information
Provider Information
NPI: 1033595574
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EL ZAWI
FirstName: AHMED
MiddleName: H. MUFTAH
NamePrefix: DR.
NameSuffix:  
Credential: DDS, MSD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 611 N IRON BRIDGE WAY
Address2:  
City: SPOKANE
State: WA
PostalCode: 992024932
CountryCode: US
TelephoneNumber: 5094448888
FaxNumber:  
Practice Location
Address1: 844 6TH ST
Address2:  
City: CLARKSTON
State: WA
PostalCode: 99403
CountryCode: US
TelephoneNumber: 2088488300
FaxNumber: 2088488306
Other Information
ProviderEnumerationDate: 08/06/2015
LastUpdateDate: 04/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDE60699876WAY Dental ProvidersDentist 

No ID Information.


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