Provider Demographics
NPI:1619352317
Name:ZANDIEH VAKILI, MATTHEW C (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:ZANDIEH VAKILI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:C
Other - Last Name:VAKILI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:460 HALSEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2122
Mailing Address - Country:US
Mailing Address - Phone:408-823-6067
Mailing Address - Fax:
Practice Address - Street 1:460 HALSEY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2122
Practice Address - Country:US
Practice Address - Phone:408-823-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist