Provider Demographics
NPI:1528458932
Name:ZARIFFARD, EHSAN (DMD)
Entity type:Individual
Prefix:
First Name:EHSAN
Middle Name:
Last Name:ZARIFFARD
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 1:220 RIVERSIDE AVE UNIT 526
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4959
Mailing Address - Country:US
Mailing Address - Phone:630-802-8652
Mailing Address - Fax:
Practice Address - Street 1:620 COMMERCE CENTER DR UNIT 155
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8803
Practice Address - Country:US
Practice Address - Phone:904-483-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 208771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry