Healthcare Provider Details

I. General information

NPI: 1679023048
Provider Name (Legal Business Name): SAM SAADAT DDS A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3327 KIMBER DR SUITE D
NEWBURY PARK CA
91320-4315
US

IV. Provider business mailing address

3327 KIMBER DR SUITE D
NEWBURY PARK CA
91320-4315
US

V. Phone/Fax

Practice location:
  • Phone: 805-499-3691
  • Fax: 805-499-4652
Mailing address:
  • Phone: 805-499-3691
  • Fax: 805-499-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58415
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number59390
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number55438
License Number StateCA

VIII. Authorized Official

Name: DR. SAM SAADAT
Title or Position: DENTIST/OWNER
Credential:
Phone: 805-499-3691