Healthcare Provider Details

I. General information

NPI: 1568900579
Provider Name (Legal Business Name): ANOOSH ZADFAR DDS, DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9929 TOPANGA CANYON BLVD
CHATSWORTH CA
91311-3602
US

IV. Provider business mailing address

9929 TOPANGA CANYON BLVD
CHATSWORTH CA
91311-3602
US

V. Phone/Fax

Practice location:
  • Phone: 818-818-5123
  • Fax: 818-818-5123
Mailing address:
  • Phone: 818-818-5123
  • Fax: 818-818-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number100253
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ANOOSH ZADFAR
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-818-5123