Provider Demographics
NPI:1154736338
Name:ZAHEDI, MISHA (DDS)
Entity type:Individual
Prefix:
First Name:MISHA
Middle Name:
Last Name:ZAHEDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 W MONTAUK HWY
Mailing Address - Street 2:BUILDING B, SUITE 8
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2363
Mailing Address - Country:US
Mailing Address - Phone:631-728-8482
Mailing Address - Fax:
Practice Address - Street 1:188 W MONTAUK HWY
Practice Address - Street 2:BUILDING B, SUITE 8
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2363
Practice Address - Country:US
Practice Address - Phone:631-728-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY057990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program