Provider Demographics
NPI:1548846231
Name:BAGHAIE, SABRINA REVA
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:REVA
Last Name:BAGHAIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N BLANCHARD ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-4503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 SIMPSON PARK RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4299
Practice Address - Country:US
Practice Address - Phone:704-484-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2022-10-03
Deactivation Date:2022-08-08
Deactivation Code:
Reactivation Date:2022-08-29
Provider Licenses
StateLicense IDTaxonomies
NC129281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty