Healthcare Provider Details

I. General information

NPI: 1437886967
Provider Name (Legal Business Name): MOHSEN ASSADI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6512 LONETREE BLVD STE 100
ROCKLIN CA
95765-5883
US

IV. Provider business mailing address

14026 S 36TH PL
PHOENIX AZ
85044-4581
US

V. Phone/Fax

Practice location:
  • Phone: 916-885-0871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD011553
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS108437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: