Healthcare Provider Details

I. General information

NPI: 1063241966
Provider Name (Legal Business Name): ZARRINKELK-SIAVASH-COPPELSON DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 TOWNSGATE RD STE 120
THOUSAND OAKS CA
91361-3030
US

IV. Provider business mailing address

5200 TELEGRAPH RD STE B
VENTURA CA
93003-4185
US

V. Phone/Fax

Practice location:
  • Phone: 805-728-1616
  • Fax: 805-728-1630
Mailing address:
  • Phone: 805-377-8990
  • Fax: 805-648-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. HOOMAN ZARRINKELK
Title or Position: PARTNER
Credential: DDS
Phone: 805-648-5121