Provider Demographics
NPI:1528463957
Name:ZAKIZADEH, PARISA (DDS, MS)
Entity type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:ZAKIZADEH
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 G TIERRASANTA BLVD.
Mailing Address - Street 2:#253
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2605
Mailing Address - Country:US
Mailing Address - Phone:858-229-7745
Mailing Address - Fax:
Practice Address - Street 1:885 CANARIOS COURT
Practice Address - Street 2:#208
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-421-3374
Practice Address - Fax:619-421-3410
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics