Provider Demographics
NPI:1740504059
Name:ZAHEDI, PETER I (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ZAHEDI
Suffix:I
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:ZAHEDI
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3331
Mailing Address - Country:US
Mailing Address - Phone:415-453-1241
Mailing Address - Fax:415-453-2056
Practice Address - Street 1:905 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3331
Practice Address - Country:US
Practice Address - Phone:415-453-1241
Practice Address - Fax:415-453-2056
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice