Healthcare Provider Details

I. General information

NPI: 1720990120
Provider Name (Legal Business Name): EAST SACRAMENTO MODERN DENTISTRY, PROF. CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 FOLSOM BLVD
SACRAMENTO CA
95819-4606
US

IV. Provider business mailing address

PO BOX 660041
DALLAS TX
75266-0041
US

V. Phone/Fax

Practice location:
  • Phone: 279-221-8240
  • Fax: 279-205-2423
Mailing address:
  • Phone: 714-845-8890
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NAZANIN ABDEHOO
Title or Position: OWNER
Credential: DMD
Phone: 279-221-8240