Healthcare Provider Details

I. General information

NPI: 1700652658
Provider Name (Legal Business Name): SAGHIZADEH DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEWBURY RD STE 280
NEWBURY PARK CA
91320-6445
US

IV. Provider business mailing address

1000 NEWBURY RD STE 280
NEWBURY PARK CA
91320-6445
US

V. Phone/Fax

Practice location:
  • Phone: 805-375-9383
  • Fax: 805-375-9386
Mailing address:
  • Phone: 805-375-9383
  • Fax: 805-375-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: PEYMAN SAGHIZADEH
Title or Position: DOCTOR
Credential: DDS
Phone: 310-666-7386