Provider Demographics
NPI:1144686981
Name:KAMI DENTAL, PLLC
Entity type:Organization
Organization Name:KAMI DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMBIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SADRAEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-943-0375
Mailing Address - Street 1:1320 N ZARAGOZA RD STE 110
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7930
Mailing Address - Country:US
Mailing Address - Phone:818-943-0375
Mailing Address - Fax:
Practice Address - Street 1:1320 N ZARAGOZA RD STE 110
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7930
Practice Address - Country:US
Practice Address - Phone:818-943-0375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-09
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty