Healthcare Provider Details

I. General information

NPI: 1245134527
Provider Name (Legal Business Name): SUZAN SABAGH DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11980 SAN VICENTE BLVD STE 814
LOS ANGELES CA
90049-6606
US

IV. Provider business mailing address

15507 S NORMANDIE AVE # 424
GARDENA CA
90247-4013
US

V. Phone/Fax

Practice location:
  • Phone: 310-493-1133
  • Fax:
Mailing address:
  • Phone: 310-493-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SUZAN SABAGH
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-493-1133