Healthcare Provider Details

I. General information

NPI: 1134368491
Provider Name (Legal Business Name): SAGHATCHI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 NEWPORT BLVD STE E267
COSTA MESA CA
92627-5013
US

IV. Provider business mailing address

1835 NEWPORT BLVD STE E267
COSTA MESA CA
92627-5013
US

V. Phone/Fax

Practice location:
  • Phone: 949-574-0100
  • Fax: 949-574-0101
Mailing address:
  • Phone: 949-574-0100
  • Fax: 949-574-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45970
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number49877
License Number StateCA

VIII. Authorized Official

Name: DR. FARSHAD SAGHATCHI
Title or Position: PRESIDENT
Credential:
Phone: 949-574-0100