Provider Demographics
NPI:1710180773
Name:ZAVARI DMD PC, BITA (DMD)
Entity Type:Individual
Prefix:
First Name:BITA
Middle Name:
Last Name:ZAVARI DMD PC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW CEDAR HILLS BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5439
Mailing Address - Country:US
Mailing Address - Phone:503-292-2125
Mailing Address - Fax:503-200-1935
Practice Address - Street 1:9053 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2435
Practice Address - Country:US
Practice Address - Phone:503-292-3519
Practice Address - Fax:503-297-7712
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD77711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice