Healthcare Provider Details

I. General information

NPI: 1942769518
Provider Name (Legal Business Name): COLTON DENTAL & ORTHODONTICS DR ZAGHI DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 VIA LATA
COLTON CA
92324-3918
US

IV. Provider business mailing address

944 VIA LATA
COLTON CA
92324-3918
US

V. Phone/Fax

Practice location:
  • Phone: 909-340-9100
  • Fax: 909-340-9600
Mailing address:
  • Phone: 909-340-9100
  • Fax: 909-340-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: FARSHAD A. ZAGHI
Title or Position: CEO
Credential: DMD
Phone: 408-396-4530