Provider Demographics
NPI:1831529155
Name:DR ZAVARI DENTAL PC
Entity type:Organization
Organization Name:DR ZAVARI DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-292-2125
Mailing Address - Street 1:1600 SW CEDAR HILLS BLVD
Mailing Address - Street 2:SUITE 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 1:1600 SW CEDAR HILLS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229
Practice Address - Country:US
Practice Address - Phone:503-292-2125
Practice Address - Fax:503-200-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7771261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental