MEDICARE: POURIA SADRI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	51133	CA

General Provider Information

NPI Number	:	1659584175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POURIA SADRI DDS

Provider Business Mailing Address
First Line	:	23517 MAIN ST
Second Line	:	SUITE 106
City	:	CARSON
State	:	CA
Zip	:	90745-5251
Country	:	US
Telephone Number	:	310-513-0222
Fax Number	:	310-513-1352

Provider Business Practice Location Address
First Line	:	23517 MAIN ST
Second Line	:	SUITE 106
City	:	CARSON
State	:	CA
Zip	:	90745-5251
Country	:	US
Telephone Number	:	310-513-0222
Fax Number	:	310-513-1352

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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Directions to “ POURIA SADRI DDS” Practice Location

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