Provider Demographics
NPI:1043255458
Name:KARKHANEHCHI, MARZIEH (DDS)
Entity type:Individual
Prefix:
First Name:MARZIEH
Middle Name:
Last Name:KARKHANEHCHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4466 BLACK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6143
Mailing Address - Country:US
Mailing Address - Phone:925-846-2222
Mailing Address - Fax:
Practice Address - Street 1:4466 BLACK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6143
Practice Address - Country:US
Practice Address - Phone:925-846-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics