Provider Demographics
NPI:1386088656
Name:CHARLES ZAHEDI DENTAL CORPORATION
Entity type:Organization
Organization Name:CHARLES ZAHEDI DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZAHEDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-922-4450
Mailing Address - Street 1:4590 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2028
Mailing Address - Country:US
Mailing Address - Phone:855-996-3872
Mailing Address - Fax:888-872-5556
Practice Address - Street 1:4221 MACARTHUR BLVD
Practice Address - Street 2:SUITE B3
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:855-996-3872
Practice Address - Fax:888-872-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty