Provider Demographics
NPI:1881049179
Name:ZANDEVAKILI, SASCHA EALIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SASCHA
Middle Name:EALIA
Last Name:ZANDEVAKILI
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:EMORY CLINIC BUILDING B STE 2300
Mailing Address - Street 2:1365 CLIFTON ROAD, NE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-4500
Mailing Address - Fax:
Practice Address - Street 1:4125 SORRENTO VALLEY BLVD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1423
Practice Address - Country:US
Practice Address - Phone:858-997-2701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1025441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program