Healthcare Provider Details

I. General information

NPI: 1548147903
Provider Name (Legal Business Name): ZAVERDINOS DENTAL PRACTICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 W MADISON AVE STE 200
EL CAJON CA
92020-3456
US

IV. Provider business mailing address

1273 LAS FLORES DR
CARLSBAD CA
92008-1030
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-6364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MICAELA ZAVERDINOS
Title or Position: OWNER
Credential: DMD, MPH, MSD
Phone: 215-505-0708