1689282782 NPI number — MOHAMMAD ALI ZAREH DDS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689282782 NPI number — MOHAMMAD ALI ZAREH DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAMMAD ALI ZAREH DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689282782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 LAGUNA RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92835-3633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-526-3655
Provider Business Mailing Address Fax Number:
714-738-6495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 LAGUNA RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92835-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-526-3655
Provider Business Practice Location Address Fax Number:
714-738-6495
Provider Enumeration Date:
07/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ZAREH
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-526-3655

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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