Healthcare Provider Details

I. General information

NPI: 1518164169
Provider Name (Legal Business Name): RAMIN SANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8987 W OLIVE AVE STE 120
PEORIA AZ
85345-9126
US

IV. Provider business mailing address

8987 W OLIVE AVE STE 120
PEORIA AZ
85345-9126
US

V. Phone/Fax

Practice location:
  • Phone: 623-773-1882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD4896
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: