Healthcare Provider Details

I. General information

NPI: 1043255458
Provider Name (Legal Business Name): MARZIEH KARKHANECHI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12677 ALCOSTA BLVD STE 575
SAN RAMON CA
94583-4423
US

IV. Provider business mailing address

4466 BLACK AVE SUITE B
PLEASANTON CA
94566-6143
US

V. Phone/Fax

Practice location:
  • Phone: 415-612-0256
  • Fax:
Mailing address:
  • Phone: 925-846-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number54003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: