Provider Demographics
NPI:1962565119
Name:ZARRINNEGAR, GHOLAM-REZA (DDS)
Entity type:Individual
Prefix:DR
First Name:GHOLAM-REZA
Middle Name:
Last Name:ZARRINNEGAR
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 1:19321 VICTORY BLVD
Mailing Address - Street 2:SUITE 357
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6302
Mailing Address - Country:US
Mailing Address - Phone:818-344-0177
Mailing Address - Fax:818-344-3386
Practice Address - Street 1:7033 RESEDA BLVD.
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335
Practice Address - Country:US
Practice Address - Phone:818-344-0177
Practice Address - Fax:818-344-3386
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice