Provider Demographics
NPI:1033930474
Name:SADEGHEIN PRO ENDO DENTAL GROUP INC
Entity type:Organization
Organization Name:SADEGHEIN PRO ENDO DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAMYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-205-8949
Mailing Address - Street 1:8077 FLORENCE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3894
Mailing Address - Country:US
Mailing Address - Phone:562-381-2442
Mailing Address - Fax:888-977-3635
Practice Address - Street 1:8077 FLORENCE AVE STE 101
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3894
Practice Address - Country:US
Practice Address - Phone:562-381-2442
Practice Address - Fax:888-977-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty