Provider Demographics
NPI:1861164568
Name:SADRMANOCHEHRINAEINI, AMIRREZA (DDS)
Entity type:Individual
Prefix:DR
First Name:AMIRREZA
Middle Name:
Last Name:SADRMANOCHEHRINAEINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 ARDILL CRESCENT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4G 5S7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3720 CALL FIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2766
Practice Address - Country:US
Practice Address - Phone:940-249-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX379101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice