Provider Demographics
NPI:1386925121
Name:ZANZI, NADER M (DMD)
Entity type:Individual
Prefix:
First Name:NADER
Middle Name:M
Last Name:ZANZI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 DOUGLAS BLVD
Mailing Address - Street 2:STE. F
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6276
Mailing Address - Country:US
Mailing Address - Phone:916-780-7676
Mailing Address - Fax:
Practice Address - Street 1:6910 DOUGLAS BLVD
Practice Address - Street 2:STE. F
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6276
Practice Address - Country:US
Practice Address - Phone:916-780-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice