Healthcare Provider Details

I. General information

NPI: 1558614255
Provider Name (Legal Business Name): ALIZADEH & SALEH, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 MARCONI AVE STE 100
SACRAMENTO CA
95821-4379
US

IV. Provider business mailing address

4350 MARCONI AVE #100
SACRAMENTO CA
95821
US

V. Phone/Fax

Practice location:
  • Phone: 916-487-7148
  • Fax: 916-487-1468
Mailing address:
  • Phone: 916-487-7148
  • Fax: 916-487-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number51543
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ASHKAN ALIZADEH
Title or Position: OWNER
Credential: D.D.S.
Phone: 916-487-7148