Healthcare Provider Details

I. General information

NPI: 1215602479
Provider Name (Legal Business Name): MANIZHA REZAYEE SHARAF DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 CENTRAL AVE
CERES CA
95307-1806
US

IV. Provider business mailing address

1846 BANKSTON DR
TRACY CA
95304-5924
US

V. Phone/Fax

Practice location:
  • Phone: 209-537-7357
  • Fax:
Mailing address:
  • Phone: 503-405-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11499
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS110815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: