Healthcare Provider Details

I. General information

NPI: 1841431566
Provider Name (Legal Business Name): MOHAMMAD HASSAN SADEGHI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 PEBBLE BEACH DR
APTOS CA
95003-5725
US

IV. Provider business mailing address

43 PEBBLE BEACH DR
APTOS CA
95003-5725
US

V. Phone/Fax

Practice location:
  • Phone: 831-464-3011
  • Fax: 831-685-2408
Mailing address:
  • Phone: 831-464-3011
  • Fax: 831-685-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number42603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: