Provider Demographics
NPI:1225164460
Name:MODARESSI, ZAHRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZAHRA
Middle Name:
Last Name:MODARESSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 ALCOSTA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2837
Mailing Address - Country:US
Mailing Address - Phone:925-828-1171
Mailing Address - Fax:925-828-1171
Practice Address - Street 1:1900 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE B-2
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3690
Practice Address - Country:US
Practice Address - Phone:707-427-3111
Practice Address - Fax:707-427-3893
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice