Provider Demographics
NPI:1407868664
Name:TEDINI, ZIAD (DDS)
Entity type:Individual
Prefix:DR
First Name:ZIAD
Middle Name:
Last Name:TEDINI
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 1:11230 SORRENTO VALLEY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1338
Mailing Address - Country:US
Mailing Address - Phone:858-485-9126
Mailing Address - Fax:
Practice Address - Street 1:11230 SORRENTO VALLEY RD STE 130
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1338
Practice Address - Country:US
Practice Address - Phone:858-485-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11741122300000X
CA57199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN984684100Medicaid
MN984684100Medicaid
U95733Medicare UPIN