Provider Demographics
NPI:1437173770
Name:ZANDI, DAVID PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PHILLIP
Last Name:ZANDI
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 1:33 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-2130
Mailing Address - Country:US
Mailing Address - Phone:765-473-5300
Mailing Address - Fax:765-473-7845
Practice Address - Street 1:33 W 7TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-2130
Practice Address - Country:US
Practice Address - Phone:765-473-5300
Practice Address - Fax:765-473-7845
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008167B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist