Provider Demographics
NPI:1467564088
Name:ZARE, FARDIN (DDS)
Entity Type:Individual
Prefix:
First Name:FARDIN
Middle Name:
Last Name:ZARE
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 1:8709 HUNTERS GREEN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2309
Mailing Address - Country:US
Mailing Address - Phone:813-991-1088
Mailing Address - Fax:813-991-4817
Practice Address - Street 1:8709 HUNTERS GREEN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2309
Practice Address - Country:US
Practice Address - Phone:813-991-1088
Practice Address - Fax:813-991-4817
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN146941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1803562OtherUNITED CONCORDIA
FL56949OtherBLUE CROSS / BLUE SHIELD