Provider Demographics
NPI:1558602508
Name:ZAHEDI, CHARLES S (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:ZAHEDI
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4667 MACARTHUR BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1867
Mailing Address - Country:US
Mailing Address - Phone:888-871-0009
Mailing Address - Fax:
Practice Address - Street 1:4667 MACARTHUR BLVD STE 230
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1867
Practice Address - Country:US
Practice Address - Phone:888-871-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist