Provider Demographics
NPI:1700030384
Name:ZADEH, ALI (DDS)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:ZADEH
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 1:30204 INDUSTRIAL PKWY SW.
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544
Mailing Address - Country:US
Mailing Address - Phone:510-475-1955
Mailing Address - Fax:510-422-5487
Practice Address - Street 1:30204 INDUSTRIAL PKWY SW.
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544
Practice Address - Country:US
Practice Address - Phone:510-475-1955
Practice Address - Fax:510-422-5487
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58779122300000X, 1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist