Provider Demographics
NPI:1568900579
Name:ANOOSH ZADFAR DDS, DENTAL CORPORATION
Entity Type:Organization
Organization Name:ANOOSH ZADFAR DDS, DENTAL CORPORATION
Other - Org Name:A2Z DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANOOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADFAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-818-5123
Mailing Address - Street 1:9929 TOPANGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3602
Mailing Address - Country:US
Mailing Address - Phone:818-818-5123
Mailing Address - Fax:818-818-5124
Practice Address - Street 1:9929 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3602
Practice Address - Country:US
Practice Address - Phone:818-818-5123
Practice Address - Fax:818-818-5123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1002531223G0001X
CA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty