Provider Demographics
NPI:1902092075
Name:MEKOUAR, ZACK HICHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZACK
Middle Name:HICHAM
Last Name:MEKOUAR
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 1:9616 GEORGETOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2638
Mailing Address - Country:US
Mailing Address - Phone:703-347-1282
Mailing Address - Fax:
Practice Address - Street 1:13900 NOBLEWOOD PLZ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1449
Practice Address - Country:US
Practice Address - Phone:703-347-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411070122300000X
DCDEN1000523122300000X
MD133901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist