Healthcare Provider Details

I. General information

NPI: 1053054718
Provider Name (Legal Business Name): MICAELA ZAVERDINOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1273 LAS FLORES DR
CARLSBAD CA
92008-1030
US

IV. Provider business mailing address

1273 LAS FLORES DR
CARLSBAD CA
92008-1030
US

V. Phone/Fax

Practice location:
  • Phone: 760-434-2526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS106226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: